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61st Congress \ SENATE I Document 

1st Session f v I No. 48 



SOME SCIENTIFIC CONCLUSIONS 

CONCERNING 

THE ALCOHOLIC PROBLEM AND ITS 
PRACTICAL RELATIONS TO LIFE 



PAPERS READ AT THE SEMIANNUAL MEETING 
OF THE AMERICAN SOCIETY FOR THE STUDY 
OF ALCOHOL AND OTHER DRUG NARCOTICS, AT 
WASHINGTON, D. C, MARCH 17, 18, AND 19, 1909 



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PRESENTED BY MR. GALLINGER 
May 17, 1909.— Ordered to be printed 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1909 



3 






61st Congress \ SENATE i Document 

1st Session J \ No. 48 



SOME SCIENTIFIC CONCLUSIONS 

CONCERNING \ , ^ , 

THE ALCOHOLIC PROBLEM AND ITS 
PRACTICAL RELATIONS TO LIFE 



PAPERS READ AT THE SEMIANNUAL MEETING 
OF THE AMERICAN SOCIETY FOR THE STUDY 
OF ALCOHOL AND OTHER DRUG NARCOTICS, AT 
WASHINGTON, D. C, MARCH 17, 18, AND 19, 1909 



e^, ( G^&eriz- lrr/0^ 



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PRESENTED BY MR. GALLINGER 
May 17, 1909.— Ordered to be printed 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1909 



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INTRODUCTORY NOTE. 



The following papers were read at the semiannual meeting of the 
American Association for the Study of Alcohol and Other Narcotics, 
held in Washington, D. C., March 17, 18, and 19, 1909. 

This association was organized in 1870, and is composed exclu- 
sively of physicians and scientific persons interested in the exact 
study of alcohol and the diseases associated with and following 
from its use. 

This was the first effort of medical men in modern times to take 
up the alcoholic problem as a strictly scientific study, and for over 
twenty years was the only society in the world discussing this 
subject. 

At present there are two similar societies in Europe, and for many 
years great congresses have been held every two years in different 
parts of Europe for the general discussion of this problem. 

These papers are presented as the most authoritative contributions 
and conclusions to this subject, and not only indicate what has been 
done, but point out great possibilities for further and more exact 
work. 

Their practical value will be evident to every reader, particularly 
as they cover several most important phases of the subject, espe- 
cially the latest studies of the action of alcohol on the cell and tissue, 
and the influence of certain causes, also means of treatment and 
possibilities of restoration and prevention. 

The publication and dissemination of these papers will be wel- 
comed in every section of the country for the reason that they supply 
authoritative conclusions and facts from the latest medicai studies 
that are unquestionable. 

It is only from contributions of this character that the public can 
learn the real facts and their application in the means of prevention 
and cure. 

The secretary of this association is Dr. T. D. Crothers, of Hart- 
ford, Conn. 

3 



TABLE OF CONTENTS. 



Papers Giving Conclusions from Recent Laboratory Researches Con- 
cerning the Action of Alcohol on Cell and Tissue. 

Pa^e. 

" Lesions of the nerve cells and vascular tissues produced by acute experi- 
mental alcoholic poisoning," by H. J. Berkeley, M. D., of Baltimore, Md., 
clinical professor of psychiatry in Johns Hopkins University 9 

" Teachings from laboratory researches on the action of alcohol on the cell and 
tissue," by WinfieldS. Hall, M. D., Chicago, 111., professor of physiology in 
the Northwestern University 1G 

" Water, alcohol, and neuropathy in man," by C. H. Hughes, M. D., St. Louis, 
Mo., editor of The Alienist and Neurologist, and dean of Barnes Medical Col- 
lege 20 

Papers Presenting Special Causes and Conditions Favorable to the 
Growth of Alcoholic Inebriety. 

"Toxins as active causes of inebriety," by G. H. Benton, M. D., Chester, W. Va., 
superintendent Sterling- Worth Sanitarium 25 

"Alcohol as an adulterant in foods and drugs," by H. W. Wiley, M. D., Wash- 
ington, D. C, chemist of the Government Agricultural Department 33 

"Alcohol and its influence in pulmonary tuberculosis," by H. J. Achard, M. D., 
Asheville, N. C 35 

"Alcohol and its influence on public health," by G. O. Webster, M. D., Chicago, 
111., president of the Illinois State Board of Health 42 

"Dyspepsia and its relations to inebriety," by D. H. Kress, M. D., Takoma 
Park, Washington, D. C, superintendent of the Washington Sanitarium. ... 50 

Papers Relating to the Questions of Responsibility, and the Public 

Care of Inebriates. 

"Mental responsibility in acute and chronic alcoholic intoxication," by A. 
Gordon, M. D., Philadelphia, Pa., professor of mental and nervous diseases 
in the Jefferson Medical College 63 

"The medico-legal care of alcoholic defectives," by G. Alfred Lawrence, M. D., 
New York City, professor of mental diseases in the Post Graduate College, 
New York 71 

"The relation of the pauper inebriate to the state from an economic point of 
view," by Lewis D. Mason, M. D., Brooklyn, N. Y., vice-president of the v 

American Society for the Study of Alcohol and Drug Narcotics 74 

Papers Discussing the General and Special Forms of Treatment 
Found Most Available in Practice. 

"Questions of diet in the treatment of inebriety," by J. H. Kellogg, M. D., Bat- 
tle Creek, Mich., superintendent of the Battle Creek Sanitarium 87 

"A plea for the establishment of hospitals for the rational treatment of inebri- 
ates," by C. A. Rosenwasser, M. D., Newark, N. J., chairman of the New Jer- 
sey commission of crime and dependency, etc 102 

"The psychical therapeutics of inebriety," by J. D. Quackenbos, M. D., New 
York City, specialist in psychological treatment 109 

"The results of treatment of inebriety by hydropathic methods, " by J. C. Walton, 
M. D., Richmond, Va., superintendent of the Virginia Electric Sanitarium. . 117 

5 



6 TABLE OF CONTENTS. 

Papers Relating to the Alcoholic Problem in its Sociological, Physio- 
logical, and Medical Aspects. 

Page. 
„/ "The alcoholic problem in every-day life," by H. A. Kelly, Baltimore, Md., 

professor of diseases of women in the Johns Hopkins Hospital 121 

"Some effects of alcohol on the body from a scientific view point," by B. 0. 
Keister, M. D., Roanoke, Va., superintendent Sanitarium for Mental and 

Nervous Diseases 127 

^ "The effects of alcohol on temperament, relating to race and nationality," by 

W. B. Parks, M. D., Atlanta, Ga., editor of the Altruist 133 

"The practical workings of a bureau for the collection and dissemination of 
facts and data relating to the alcoholic problem," by Miss C. F. Stoddard, 
Boston, Mass., secretary of the Scientific Temperance Federation Bureau. . . 137 

"The future of the alcoholic problem," by T. D. Crothers, M. D., Hartford, 
Conn. , superintendent Walnut Lodge Hospital 140 

"Alcohol — its place in medical practice," by W. H. Waugh, M. D., Chicago, 
111., editor Clinical Medicine, etc 144 

" The great temperance pioneers in the medical profession and their work for 

the last century," by Henry O. Marcy, A. M., M. D., LL. D., of Boston 152 

J" The psychological basis of inebriety: its aetiological and social factors; reme- 
dies." by Tom A. Williams, M. B., C. M., Edin. of Washington, D. C 158 

"The Turkish baths in inebriety," by Charles H. Shepard, M. D., 81 Colum- 
bia Heights, Brooklyn,N. Y 170 



PAPERS GIVING CONCLUSIONS FROM RECENT LABORATORY 

RESEARCHES CONCERNING THE ACTION OF ALCOHOL 

ON CELL AND TISSUE. 



LESIONS OF THE NERVE CELL AND VASCULAR TISSUES 
PRODUCED BY ACUTE EXPERIMENTAL ALCOHOLIC 
POISONING. 



By Henry J. Berkley. 
Clinical professor of psychiatry, Johns Hopkins University, Baltimore. 



The effect of ethyl alcohol, in its pure form, upon the organism 
differs in some ways from that of spirituous liquors of which it is the 
chief constituent, doubtless from the fact that certain ethers are 
present in the spirits and absent from the alcohol. The first result, 
after the ingestion of a moderate quantity of ethyl alcohol in 
man — a fluid ounce, for example, of absolute alcohol properly di- 
luted — is to cause a fall of from 15 to 20 beats a minute in the heart's 
action, accompanied by some hardening of the quality of the pulse. 
This is followed, almost immediately, by a feeling of muscular lassi- 
tude, then mental confusion, both of which increase gradually, and 
in an hour or two are lost. 

A few instances of its more continued effects on man may be cited. 
One man of 40 years, who voluntarily subjected himself to a months' 
course of ethyl alcohol, in daily doses, beginning with 2 ounces and 
gradually increasing to 4 ounces, taken mainly in the late evening, 
exhibited the following symptoms: After the initial vascular dis- 
turbance came considerable mental confusion, inability to control 
the voluntary muscles, and intense sleepiness. On the following 
morning, after a period of from six to seven hours profound sleep, 
there was considerable irritability of the heart's action, which per- 
sisted up to 3 or 4 o'clock the following afternoon, mental lassitude, 
and difficulty in keeping up with the daily routine work. By the end 
of the month there was well-marked and persistent irritability of the 
heart's action, palpitation, at times a feeling of praecordial anxiety 
with some difficulty in the respiration, a pulse showing a considerable 
increase in tension, and decided evidence of dilatation of the periph- 
eral arteries, the indications of beginning fatty changes in the 
heart and muscularis of the blood vessels. With these symptoms 
were others indicating a considerable digestive disturbance m the 
form of mucous diarrheas, neuralgic pains in the forehead and limbs, 
together with a lessened ability to think clearly at any time, and 
mental irritability. When the alcohol was stopped, all the symp- 
toms, inclusive of the arterial dilatation receded rapidly, and soon 
disappeared. 

A second individual, who drank 95 per cent alcohol as a beverage in 
the place of whisky, to the extent of a pint or more a day, at the end of 
three months exhibited profound mental changes in the form of pro- 
nounced loss of memory for recent events, delusions of persecution; 



10 THE ALCOHOLIC PROBLEM. 

and on the somatic side, profound cutaneous anesthesias, with loss of 
the knee jerks and other deep reflexes, also the indications of a fatty 
heart muscle and dilated arteries. Tremor, loss of tone of the mus- 
culature, difficulty in articulation, incoordination of the voluntary 
movements, as well as lancinating pains in the lower extremities were 
also noted. He recovered almost completely after a three months' 
sojourn at a sanitarium. 

In a third individual — a physician — who consumed a liter bottle of 
absolute alcohol a day for a period of three months, the changes were 
more profound. The heart's action grew weak, weaker and more 
irregular, complete anesthesia of the skin surfaces, with entire loss of 
the deep and superficial reflexes supervened. With these came vari- 
ous visceral paraesthesias; then a rapid dementia began, which soon 
became profound, and shortly after the end of the three months he 
died from failure of the heart's action. 

The ingestion of large quantities of ethyl alcohol is always followed 
by profound disorganization of the cardiac functions, and a single dose 
of 6 or 8 ounces may be followed by rapid death even in persons who 
are accustomed to the habitual use of spirits. In these instances there 
is a gradual lowering of the circulation, subnormal temperature, bluing 
of the extremities, and a gradual slacking of the cardiac action until 
the exitus. 

The microscopic pathological effects of acute alcoholic poisoning 
upon the human organism is practically unknown, nor is it possible to 
obtain material for these examinations in sufficiently fresh condition 
from cases of delirium tremens that have died as a result of their 
debauches, as it is from the tissues of the lower animals that have 
been subjected to practically the same course of treatment. We have 
therefore availed ourselves of the material, furnished during the course 
of certain studies by Dr. Julius Friedenwald, upon the effects of alco- 
hol on the tissues of rabbits. The alcohol was administered in slowly 
increasing doses until the animal had established a certain tolerance 
to the drug, then increasing it to a considerable amount, which was 
maintained until the animal died. 

While the quantity given the animals was large, it can hardly be 
said to exceed the amount taken by many men while on a protracted 
debauch, and from which they eventually recover, perhaps, after an 
attack of delirium tremens or other alcoholic psychosis, and fell con- 
siderably below that of the man cited above, who took a liter a day. 

Thus an individual weighing 150 pounds would take in the same 
proportion fifty times the quantity of alcohol of a 3-pound rabbit, 
and accordingly would attain a daily allowance of 750 cubic centi- 
meters absolute alcohol, equal to about 1,500 cubic centimeters of 
ordinary whisky, with the difference that the ethyl alcohol is perhaps 
less deleterious to the tissues than the blended whiskies of commerce. 

Three rabbits were used in this study: 

Rabbit A, weighing 1,220 grams, received 5 cubic centimeters 
diluted alcohol on September 26, and the amount was gradually 
increased up to 15 cubic centimeters a day, which was maintained 
until October 21, the date of death. In all he received 190 cubic 
centimeters alcohol. After the exitus the body weighed 780 grams, 
and at the autopsy the principal microscopic lesion was a fatty degen- 
eration of the heart muscle. 



THE ALCOHOLIC PROBLEM. 11 

Rabbit B weighed 1,500 grams on September 30, and from that 
date received a daily allowance of from 5 to 15 cubic centimeters 
alcohol, and died on October 21, at which time he weighed 840 grams; 
also, in this case the chief demonstrable lesion was a fatty heart. 
The total amount of alcohol consumed by this rabbit was 165 cubic 
centimeters. 

Rabbit C weighed 1,490 grams. The administration of the drug in 
the same quantities was begun on October 2, and death resulted on 
October 25, by which time the weight had been reduced to 920 grams. 
This animal died in convulsions after having received a total of 260 
cubic centimeters alcohol. A fatty heart was again found. 

One point of considerable interest to be noted in this experiment is 
that the resistance of the several animals to the poison is not pro- 
portionate to their weight, but to some inherent property in their 
tissues; thus, the heaviest one received only 165 cubic centimeters, 
and the next heaviest, weighing 10 grams less, received 260 cubic cen- 
timeters before death resulted. In all the rabbits nutrition was kept 
up as well as possible by giving them suitable and dainty food. 

THE HISTOLOGICAL EXAMINATION. 

The tissues derived from the three rabbit brains were hardened in 
absolute alcohol and in Muller's fluid, while the staining for micro- 
scopic examination was done by the Nissl method, various nuclear 
dyes, and the silver phospho-molybdate procedure. 

The results are separable into three divisions, according to the 
various elements involved, which may be briefly given as — 

Blood vessels Damage positive. 

Nerve cells Damage positive, yet not so profound as in the cells of the 

blood channel walls. 
Neuroglia Damage positive as to the lymphoidal elements, negative 

for the support neuroglia. 

We will consider in their order these various pathological changes. 

THE BLOOD VESSELS WITH NUCLEAR STAINS. 

ARTERIES AND INTERMEDIARY VESSELS. 

The nuclei of the endothelial cells are everywhere swollen, in places 
are fragmented, and receive either too little or too much of the dye. 
The cellular protoplasm is also undergoing definite retrogressive alter- 
ations. The cells of the intermediary vessels look as if they had been 
subjected to severe strain (dilatation of the blood vessel), as their 
even contours are distorted, and there are many irregular bulges in 
the walls. 

The changes in the muscular layer are equally interesting. Nuclei 
are here and there absent over considerable areas of the middle wall of 
the vessel, and in those that remain certain abnormalities are appar- 
ent, the nucleus being badly stained, either wholly or in part. It is, 
however, in the substance of the muscular protoplasm that the 
lesions are most apparent, and show that the cells themselves are 
being subjected to a morbid process. They no longer have the sub- 
stance clearly stained, but it is turbid, even hyaline in appearance. 
The protoplasm, too, is considerably swollen, and its receptive quality 
to the aniline dye is no longer good. 



12 THE ALCOHOLIC PROBLEM. 

The Virchow-Robin lymph space is entirely obliterated by the 
swelling, and in those portions of the structure where the tume- 
faction is most pronounced there is also an almost complete oblitera- 
tion of the His lymph space, the outer lamina of the vessel being 
closely pressed against the limiting lining of the peripheral edge of 
the perivascular space. 

Changes in the adventitia are not nearly so distinct as in the two 
inner coats, though in places it holds considerable numbers of 
leucocytes, or these may be packed between it, in considerable 
numbers, and the outer wall of the lymph space. These white 
blood corpuscles are necrotic and swollen. 

The contents of the perivascular spaces, where the degree of com- 
pression is insufficient to obliterate them, is interesting and instruc- 
tive. In them are large numbers of leucocytes in all stages of 
disintegration, and, besides, there are frequently a number of proto- 
plasoic bodies, several times the size of a polynuclear leucocyte, 
very granular, and without nucleus, that are, probably, formed from 
the remains of the partially disintegrated lymphoid corpuscles that 
have aggregated into crescentic or ovoid shapes. Besides these 
partly organized bodies there is a quantity of detritus, finely granular 
in character, insufficient to cause, without the aid of the lymphoid 
cells, any blocking of the lymph currents. Osmic acid produces a 
slight blackening of the degenerating white corpuscles, as well as of 
the detritus within the lymph spaces, showing that fatty changes 
are present. 

The capillaries, like the intermediary vessels, are twisted and 
tortuous, the nuclei show changes similar to those in the larger 
vessels, while the cell bodies have departures from the normal in 
staining qualities, and here and there in the lumen are plugs of 
white blood corpuscles, which, from their closely packed appearance, 
must have entirely stopped the circulation of the blood in these 
vessels before death. The lumen, beyond these plugs, is entirely 
devoid of contents. 

VEINS. 

Changes in the coats of these vessels is similar to those in the 
arterial system, but aggregations of dying polynuclear corpuscles 
are more frequent, and are by far the most striking feature both of 
their contents and surroundings. 

These aggregations, which in the small vessels may vary from 
three or four to more than a dozen, are located both within and with- 
out the lumen. Within the lumen are collections of white blood 
cells filling the interior, while numbers are seen penetrating the walls. 
So vast are the collections in the perivenous spaces that the whole 
cavity is occasionally tightly filled, and the back pressure from the 
plugs as well as the compression of the vessel from the outside has 
attained such a height that in a number of instances the vessels' 
walls have ruptured, and red corpuscles are intermingled with the 
white ones and completely fill the His space. In one instance the 
site of the rupture was located in the section. 

All the leucocytes, both within and without the veins, show, with 
aniline stains, more or less evidence of disintegration, in some instances 
extending to complete disintegration of the cell. 



THE ALCOHOLIC PKOBLEM. 13 

ARTERIES. 

The medium-sized and larger arteries show individual differences 
as to the extent that they are affected by the morbid process. This 
difference would appear to depend largely upon the numbers of lym- 
phoidal plugs in the arterioles and capillaries, for where they are 
thickly scattered there the degree of arterial degeneration is greatest, 
and particularly is this true for the muscular layer. It would 
accordingly appear that at some period antedating the death of the 
animal aggregations of leucocytes formed in the smallest vessels, 
and a slowly increasing backward pressure began upon the arteries, 
insufficient to occasion complete stasis, but enough to create unusual 
pressure upon them; accordingly, this pressure in combination with 
the poisonous effects of the alcohol carried with the current of nutri- 
tive plasma, caused degeneration of the cellular elements forming 
the vascular walls, the main stress of the active process falling upon 
the inner coats of the arteries. 

This severely increased blood pressure is probably only an exag- 
geration of what ordinarily follows the administration of a moderate 
dose of spirits. Following this ingestion comes a dilatation of all 
the arteries of the body from the paralyzing effect of the drug upon 
the vaso-constrictor nerve fibers, and this endures for a variable time 
according to the quantity of alcohol partaken of. 

The mechanism of the cerebral arteries — in that they do not 
possess vaso-constrictor nerves, but are dependent upon the inherent 
contractility of the muscularis and other elements— allows of a greater 
influx of the alcoholic poison into the brain than elsewhere. The 
vascular muscular cells, under the influence of the direct action of 
the poison and free from extraneous nerve influences to urge them to a 
return to normal state, remain for a long time inert, the congestion of the 
cerebral tissues is long continued, larger amounts of poisoned blood 
pass through the brain, and incidentally a larger proportion of alcohol 
than to other ordinary tissues, such as the muscles. As a result the 
deteriorated serum, laden with the poison, is transuded in increasing 
quantities through the capillary walls, it is carried to the Lymph 
spaces surrounding the principal cerebral cells, their structures are 
bathed in the diluted alcohol, their activity is dulled by its narcotic 
action, and inertia and torpor of the functional activities are the result; 
finally, it is only after the entire elimination of the poison from the 
system that they resume their normal functions. 

If the amount of the poison to which the tissues are subjected is 
very considerable, as well as continued from day to day, and the 
excretory functions become clogged for a long time, the damage to 
the vascular walls is proportionally greater. In the light of the pres- 
ent experimental cases, the damage may proceed to necrotic changes 
in the endothelial lining and muscular layer; leucocytes, formed in 
other portions of the body, mass in the cerebral vessels, in part from 
the increased quantity of blood brought by the arteries not being 
promptly carried off by the venous channels, and accordingly we find 
a constant accumulation of the white corpuscular elements, termi- 
nating finally in blocking of the capillaries as well as of the smaller 
veins, diapedesis, choking of the perivascular lymphatic channels, and 
eventually damage both to the walls of the arteries by back pressure 



14 THE ALCOHOLIC PROBLEM. 

acting on a tissue already prone to undergo degenerative changes 
from the deleterious effects of a poisonous drug, and to the veins from 
abundant extravasations and transudations of the white corpuscular 
elements. 

NERVE ELEMENTS. 

Changes in the nerve cells, while definite to a certain degree, are by 
no means so intense as in the mesoblastic vascular structures. With 
aniline dyes positive degenerative changes are best determined in 
the neighborhood of the more extensively embolized vessels. Here 
the nerve cell bodies do not show the normal Nissl staining, but 
appear uniformly and finely granular, also they do not take up nearly 
so much of the dye as cells that are located in areas in which damage to 
the blood vessels is less severe. In the degenerated cells alterations 
in the nucleus and nucleolus are beginning, principally noticeable in 
the swollen and spongy state of the nucleolus, but the damage is 
not nearly so extensive or positive as in chronic alcoholism. 

The silver-molybdate method shows more extensive changes than 
the Nissl, but these are confined entirely to the cell branches, which 
are invisible in preparations by the latter method. The departures 
from the normal in the dendritic extensions do not appear every- 
where throughout the section, but like those noticeable in the aniline 
preparations are most definite where vascular damage is greatest. 

The departure from the normal in the dendrites is shown by 
extensive and irregular swellings in the course of the branches, extend- 
ing over considerable distances in their long diameter, which sud- 
denly decrease to the normal caliber of the stem. The majority of the 
lateral buds, or gemmulre, are lost over the areas of tumefaction, 
though here and there damaged ones may be found projecting from 
the sides of the enlargement. Even the dendritic stems that have no 
swellings have a considerable diminution of the number of the lateral 
buds, and those that remain have lost a part of their natural charac- 
teristics, the rounded knob of the pear-shaped bud being lost, while 
the part that remains is seen as a short, even projection from the 
sides of the protoplasmic stem. Often, also, those remaining have 
a greater thickness than is customary, from the insertion to the 
termination. Accordingly, it would appear that the remaining parts 
of the lateral buds were swollen. In places where the destructive 
process has been greatest, the gemmulae are entirely stripped off from 
the parent branch. 

So far as could be determined the axis cylinder and its collaterals 
are not implicated in the destructive process. 

NEUROGLIA. 

With the aniline stains there is no increase of fixed nuclei among 
the tissues, nor could this be expected in a semiacute process. 
With the silver stain the support elements present no variations from 
the control. On the other hand the vascular neuroglia — belonging 
as it does to the lymph excretory system of the brain — gives distinct 
evidence that the stress of excreting a vastly increased amount of 
detritus, from the rapid tissue changes present, as well as from 
working at a disadvantage under the narcotic influence of the alcohol 
contained in the nutrient serum, has been too much for its capacity. 



THE ALCOHOLIC PROBLEM. 15 

The cell bodies are larger, the protoplasmic extensions are thicker and 
more knotty, and the channeled arms extending to the perivascular 
spaces of neighboring blood vessels are more prominent than in con- 
trol preparations. 

CONCLUSIONS. 

1. In acute alcoholic poisoning, the stress of the action of the drug 
falls upon the tissues of the blood vessels' walls rather than upon 
the nervous elements of the brain. 

2. The involvement of the nerve elements is more gradual than 
that of the mesoblastic tissues, and only becomes noticeable by 
present methods of staining and examination, after the lymphatic 
channels are choked with the detritus of white blood corpuscles and 
other cellular elements. 

3. Nevertheless, the deteriorative action of ethyl alcohol on the 
nerve cell is apparent, and when prolonged, in more moderate doses 
than was administered to the three rabbits, produces well-defined 
cellular changes, as is evidenced by nucleolar and dendritic changes. 

4. In its action on the nervous tissues ethyl alcohol may be likened 
to certain other poisons, such as ricin or the toxalbumins. The 
administration of these toxins causes the same departures from the 
normal in the nerve elements, but the alcohol has a much greater 
destructive effect upon the white blood cells, as well as the cells 
composing the blood vessel walls. 

5. The effect of the drug is proportionate to the quantity admin- 
istered to the animal, as well as to the duration of its poisonous action 
before death ensues. Limited quantities continued over a consider- 
able time accomplish, in modified form, the same destructive result 
as higher doses acting during a few days. 



TEACHINGS FROM LABORATORY RESEARCHES ON THE 
ACTION OF ALCOHOL ON THE CELLS AND TISSUES. 



By Winfield S. Hall, 

Professor of physiology, Northwestern University Medical School, Chicago; president of 
the Society for the Study of Alcohol and Other Narcotics. 



As indicated in the name of our organization this society was 
founded "for the study of alcohol and other narcotics." We are 
therefore a society of students, approaching controversial questions 
with open minds, seeking the truth. 

It may be in order to set forth in some detail the 

OBJECTS OF THE SOCIETY. 

I. To promote the scientific study of alcohol and other narcotics 
particularly the etiological, physiological, therapeutical, and medico- 
legal relations, and also the sociological and clinical aspects of this 
subject. 

II. To compile and make available for others the studies of the 
investigators and the clinical observations of the physicians of all 
countries so far as they concern the relation of narcotics to man 

ILL To gather and formulate all the facts of the disease of inebriety 
and other forms of narcomania, and point out the means of cure and 
ot E? v ^ t1011 PJ various remedial and prophylactic forms of treatment 

IV. I he spirit and purpose of this society is to study alcohol and 
other narcotics in all their relations to the human economy from a 
medical point of view, independent of all previous theories and 
conclusions. 

Pursuant to one of the purposes of the society I shall mention 
briefly some of the more important recent researches and the con- 
clusions to be derived from them. 

What is, in my mind, the most important recent work in this field 
is that done by Reid Hunt in one of the experiment station labora- 
tories, and under Government auspices. Doctor Hunt* used rabbits 
and guinea pigs for his subjects, and his problem was to determine 
the influence of alcohol upon the defense of the organism against 
bacterial and other toxines. Throughout his extended and exhaust- 
ive research Doctor Hunt found uniformly that the ingestion of even 
small doses of alcohol was followed by a marked decrease of the defense 
of the system against toxins. 

a Hunt See reference in address by Professor Hall, Atlantic City, June 1907 in 
Journal of Inebriety, vol. xxx, No. 4, 1908. ' ' 



THE ALCOHOLIC PROBLEM. 17 

Others have published similar conclusions, but they were based 
upon clinical observations in which many complicating factors were 
involved, or upon animal studies much less extensive and under less 
favorable ponditions. 

We may, therefore, accept Doctor Hunt's conclusions as fina] and 
their proof absolute. 

.The important research of Beebe, a published in 1904, must be men- 
tioned in this connection. He demonstrated that when alcohol is 
given in moderate amounts the excretion of uric acid and allied sub- 
stances is notably increased. His interpretation of this was that, as 
the liver is the place where toxic substances are oxidized to protect 
the body from their action, the oxidation of alcohol in the liver 
interfered with this oxidation of other toxic substances, thus per- 
mitting them to escape, to be excreted unoxidized. 

The influence of alcohol upon muscular work has often been tested, 
either upon individuals or upon groups of men. 

Dr. A. F. Hellsten has added his research to a long list, and with the 
usual result. 6 His observations were made upon himself, testing his 
own capacity for muscular work. After preparing his muscles by 
practice in lifting heavy weights (90 kilograms), using the Johnson 
ergograph, and extending his training over several months, until his 
maximum accomplishment for a certain work period had been 
clearly established, he began the ingestion of varying doses of alcohol, 
or of sugar, or of tea. 

Doctor Hellsten found that the immediate effect of a drink of 
alcohol was — 

an increase in the amount of work done in a given time. After twelve to forty 
minutes, however, there was a diminution which lasted two hours. 
The total work capacity is especially lowered after large doses of alcohol. 

Sugar had no immediate effect, but after thirty to forty minutes 
it began to raise the work capacity and produced a noticeable increase 
in the total work done. 

Tea increased the work capacity slightly and for a short time only. 

Another investigator, Dr. H. Frey, c enters this field for a second 
time, and as a result of an extended series of observations reiterates 
the general conclusions reached in his earlier experiments. In his 
paper on "Alcohol and muscle fatigue" he says: 

Alcohol acts upon the unfatigued muscle to its disadvantage in that it lowers the 
maximum work capacity. 

The work " appears lightened for a time, because the alcohol dimin- 
ishes the feeling of fatigue." 

A small dose of alcohol taken after the muscles are already fatigued 
had the effect of "increasing the work partly through increased height 
of contraction and partly through increased endurance" 

This last result is in harmony with other work in this field and is 
easily explicable: By giving the alcohol after the muscle was fatigued 
and the contractions were decreased in height and the limit of work 
approached, the alcohol had the anaesthetic effect of "diminishing 

a Beebe: "The effect of alcohol on the excretion of uric acid in man." American 
Journal of Physiology, XII, p. 13. 

& Published in the Skandin. Arch. f. Physiol., XVI, S. 139, under the title "Ueber 
den Einrluss Alkohol, Zucker u. Thee auf die Leistungsfahigkeit des Muskels." 

c H. Frey, "Alkohol und Muskelermiidung, " Leipzig und Wien, S. 62. 

S. Doc. 48, 61-1 2 



18 THE ALCOHOLIC PEOBLEM. 

the feeling of fatigue" and because of this diminished feeling of 
fatigue the muscle would go on as if not fatigued for a short time, 
regaining for a time the height of contraction of the unf atigued or of 
the less fatigued muscle. Inasmuch as this drug effect is obtained 
just at the end of the work period, the total work accomplished for 
the period would naturally be above the average. 

Doctor Frey does not report the condition of the subject after the 
first — excitation — period had passed. Nor does he report the influ- 
ence of such a drug effect upon subsequent work periods as to total 
work done. 

It is a well-known law of physiology that anything — excitement, 
exultation, hope of victory, fear of disaster, stimulus of martial music, 
etc., or drug stimulations, or anaesthesia — which diverts one 's attention 
from or allays one's consciousness of the discomfort or pain of fatigue 
will result in an increase of work capacity at the time of the influence. 

It follows naturally that if the influence referred to is brought to 
bear at or near the end of a usual work period there ensues a Dew 
lease of work capacity and the total accomplished during the work 
period may be notably increased. But a reaction follows in which 
the work capacity is proportionately diminished. 

So we recognize as a law of physiology the following: Any work, over 
and above the normal work capacity, done under the influence of any agent 
which diverts attention from or allays consciousness of fatigue acts as 
an overload or an overdraft upon the normal working capacity, which 
overdraft will make itself manifest sooner or later in a lessened capacity 
for work commensurate with the overdraft. 

Athletic trainers and coaches, army officers, teamsters, and indi- 
vidual workers are acquainted with this inexorable law of work. 

In the light of this law, Frey's results are of especial interest. 

If we were looking for a reason for this phenomenon, so far as it 
concerns alcohol, such reason is, in part at least, furnished by F. 
Margnon, a who made a study of the muscles of a dog put into T ^~o NaF 
solution and placed in an incubator. A study of the products of 
chemical transformation under these conditions revealed the forma- 
tion of acetone, acetic acid, alcohol, carbon dioxide gas, and water, 
in a step-by-step oxidation, the process being something like the 
following : 

(1) Acetone [CH 3 -CO-CH 3 ]+20 2 =C0 2 +H 2 0+acetic acid [CH 3 -COOH]. 

(2) Acetic acid [2CH 3 -COOH]+0 2 =2C0 2 +H 2 0+alcohol [CH 3 -CH 2 OH]. 

(3) Alcohol [CH 3 -CH 2 OH]+30 2 =carbon dioxide [2C0 2 ]+water [3H 2 0]. 

- (4) Carbon dioxide and water being final or end products and ready for excretion. 

Several other investigators have found alcohol in muscle tissue, 
so that it may be accepted as a positively demonstrated fact that 
alcohol may be found as one of the mid-products of tissue and cell 
catabolism (oxidation). 

This fact has not been understood. There have been several 
interpretations of it. Here is one: "Alcohol is found in normal 
tissue. Being a normal constituent of healthy tissue, it is a proper 
substance to ingest/' The writer has heard the above presented 
seriously by a scientific man in a discussion of the physiological 
effects of alcohol. 

a F. Margnon, "Production d'alcoal et d'acetone par les muscles." Comptes ven- 
dus CXLI, 16, p. 1124. 






THE ALCOHOLIC PROBLEM. 19 

The writer would reply to that course of reasoning as follows: 
"Uric acid is found in normal tissue. Being a normal constituent 
of healthy tissue, it is a proper substance to ingest." 

When applied to uric acid the course of reasoning above seems 
absurd. Even the layman detects at once the fallacy and replies: 
"Uric acid is a waste product. Its presence in the tissues is no 
evidence that it is a proper substance to introduce into the tissues. 
When it appears in the tissues it is evidently on its way to be excreted. 
The introduction of more uric acid would be likely to embarrass or 
overtax the organs employed in getting rid of the uric acid pro- 
duced in the tissues." 

Such a course of reasoning is absolutely sound concerning this 
substance and dozens of others. 

The detection of alcohol among the mid-products of tissue oxida- 
tion is no more proof that it is a proper substance to introduce into 
the dietary in beverages than the discovery of urea, uric acid, the 
xanthin bodies, glycocoll, acetic acid, leucin, tyrosin, etc., in the 
tissues is proof that they are proper substances to put into food or 
drink. 

To sum up the results of the laboratory researches of the last 
three years one may say that as the evidence accumulates it makes 
positive the following facts: 

(1) Alcohol is a waste product of tissue metabolism. 

(2) Alcohol produces a toxic effect on living substance. 

(3) Alcohol m common with other toxic substances is oxidized in 
the body. 

(4) This oxidation is a means of defense, as the products are far 
less injurious than the alcohol. 

(5) Because of this defensive oxidation of alcohol, which takes 
place largely in the liver, the ingestion of more than a slight amount 
of that substance makes the body more liable to other toxic invasion. 

(6) Alcohol can not in the nature of the case be considered a food. 

(7) Alcohol decreases the efficiency of muscle, glands, and nervous 
system. 

(8) Alcohol is a narcotic in its drug action. 

(9) Alcohol given in minute quantities to lower animals seriously 
impairs fecundity; it leads to race suicide. 



WATER, ALCOHOL, AND NEUROPATHY IN MAN. 



By Dr. C. H. Hughes, St. Louis, Mo., 

Editor of the Alienist and Neurologist, honorary member British Medico Psychological 
Association; also of the Russian Psychiatric Society, etc. 



In the human organism as in the social life of man the enemy of 
alcohol and its potable combinations is water (H 2 0). 

Alcoholic mixtures therewith are more or less hurtful or harmless 
according to the relative admixtures of the beverage with this H 2 
in the drink. 

It is because of the strong affinity of alcohol for the fluids of the 
tissues, all the tissues of all the human organism being in great part 
water, the blood vessels and the stomach containing most, ordinarily, 
and the bones the least water, that it does its greatest harm to vital 
function and life. The cells and the nerves are literally bathed in 
serum, and this is water and salts for nutrition and support. 

And this is what alcohol takes from the tissues, unless they are 
superabundantly fortified by exceptionally resisting nature. Alcohol 
acts like Metchnicoff's neuronophages, that first suck the nerve ele- 
ments dry and open the way for their subsequent devourment. 

Alcoholic compounds with water taken into and coursing through 
the organism so impresses the neurones of the brain and spinal cord 
and the cells of the viscera as to modify them more or less markedly 
according to cell and molecular resistance, thus causing the morbid 
influences called alcoholic toxicity (toxhemia, neurotoxic, viscero- 
toxic, etc.). Alcohol's poisonous power begins with the chyme and 
chyle and ends in various degrees of paresis, paralysis, etc., of func- 
tion, varying with the quantity, quality of food and water admixture, 
and the inherent metabolic and nerve-center power of the resistance 
by the organism from responsive temporary hypernormal excita- 
tion to positive paralysis under alcoholic impression. 

Psychic center aptitudes to act wrongly under alcohol's power to 
rob the neurones of the nerve centers of their sustaining cerebro- 
spinal fluid varies from stimulated loquacity and imagination to help- 
less somnolency, positive delirium, mania, coma, paralysis, and 
somatic death. This robbing of the peripheral nervous system of its 
water of nutrition and functional support causes the phenomena of 
neuritis, multiple alcoholic neuritis, and renders the nerves, as takes 
place with the central neurones, defenseless to the direct destructive 
power of alcohol. First, function fails under water abstraction from 
these and the other tissues, then direct alcoholic destruction of 
tissue. And this is the manner in which it acts upon all the organs. 
First, by absorbing the water of the tissues, and next it makes its 
direct destructive assault on the vital organs and function. 

20 



THE ALCOHOLIC PEOBLEM. 21 

It is thus that the light wines and beers are less harmful than the 
higher proof drinks. But no physiologist has yet demonstrated the 
full extent of the harmfulness, even in its more diluted forms, 
of alcohol as a constituent of the blood or cerebro-spinal fluid, taken 
regularly as a beverage. Alcohol is the protector of the dead, but 
not of living tissue. Its best place is in the dead house and the 
pathological laboratory, where brains and other organs are to be 
saved from microbic invasion, but not where living functioning 
viscera are yet in service. 

Its transient and temporary therapeutic employment under cer- 
tain exceptional states of extreme vital depression, if thoroughly 
chaperoned through the system with an abundance of aqueous or 
lactic admixtures and rightly responsive nutrition as malted or 
peptonized milk medicinally regulated by the scientific plrysician, 
bearing its damaging affinity for the watery constituents of the vital 
tissues in view, but it is not safe for a common beverage in any of 
its present commercial forms, nor for ordinary prescription. 

It is a stealthy chemical robber, if admitted into the human sys- 
tem, a thief of the vitality of the tissues, especially of the psychic 
neurones and of the highest centers of organic life. To be longer 
deceived by it is not wise, for its promises of strength are mocking 
lies. Its semblance of power are simply nerve center disturbances 
that end in ultimate weakness and destruction. The sting of the 
adder is in its poisonous trail through the organism unless we extract 
its sting, when we employ it, by completely supporting the tissues 
against its depredations in the manner indicated. This serpent of 
the still can only be successfully fought in the system as in society 
by a temperate abstinence and plenty of water. It is the greatest 
of hydrophiles among beverages. 

It persists in its attacks on the tissues until they have no water of 
life in them, and if we do not guard them well it destroys their vital 
power. And so it robs the brain of its normal functioning capacity, 
impairing it in mental and psycho-motor and moral capabilities. 

Thus far has science tracked it and proven its crime against the 
organism — its enmity against normal nature in blood and every viscus, 
including most of all the brain — why then should clear-eyed science 
look with complacency upon the popular use of this destructive bever- 
age — why, as physicians, prescribe it for drink? Why omit admonitions 
against this enemy which man so often takes "in at his mouth to steal 
away his brains V 1 

One of the chief effects of alcohol being a drought of all tissue terri- 
tory of the human organism, as shown not only in experimental and 
post-mortem evidence, but in the intense, overmastering thirst for 
water or milk after an alcoholic debauch, we find, as might have been 
expected without further proof, the shriveling of the cells of organic 
building and function. As the inferior animals may be stunted in 
development by it, so are organs arrested in growth and damaged in 
structure and function by it. These ravages are too familiar to phy- 
sicians accustomed to study the effects of alcohol on the cadaver to 
need recounting. The indurative changes in organs made possible 
by the withdrawal of the physiological guardianship of the water of 
the tissues are shown, not only in the direct induration, as of hepatic 
and arterio sclerosis, but in the many septic destructive processes 
where toxic germs get into vital points, because of denudation, become 



22 THE ALCOHOLIC PROBLEM. 

the true water of life, not the spurious aqua vitae of our mistaken 
ancestors, is not on guard at the doorways of tissue and visceral life. 
Such are the gastric and gastro-intestinal, hepatic, renal, and other 
ulceration enemies of organic life and function — for it is when the 
phagocytes are not numerous enough or vigorous enough and the 
metabolic powers are below par and the neurenogen functions are not 
what they ought to be for lack of the water of proper organization 
which alcohol takes away, that the disease-engendering enemies of 
normal protective vital movement get in to harm and destroy. The 
brain needs water, nutrition, and rest more and alcohol less for its 
right adjustment to environment and longevity in our civilization. 

A delirium-tremens patient of mine who lived under the delusion 
that from his repeated recoveries that he would always get well, 
finally became alarmed when the eighteenth or nineteenth attack 
kept him in bed and house longer than usual and more shattered in 
brain and general nervous system, finally decided, in the next attack 
and but one preceding his death, that he would call the priest, for 
he was a devout Catholic when alcohol brought him prostrate to bed. 
At this one of my visits the priest came out smiling, and as he would 
not enlighten me I asked the patient what he said. He answered 
that when the father asked him to proceed with his confession he had 
said to him that he could not recall all he had done of evil in the 
world since his last confession and was afraid he would die before he 
got through if he attempted it. So he said, " Father, I have never 
stolen anything or murdered or gone away with another man's wife, 
but whatever else there is of evil against me I guess I am guilty." 

But alcohol has done all of this in the world and more. It has 
done the things in addition that this poor inebriate escaped. He 
died in the next following seizure. 

In England in a controversy now going on between the brewers 
and scientific experts this question of the saving relation in the 
human system of water to alcoholization is inadvertently recognized 
by the brewery interest through their representative, Mr. Edwyn 
Barclay, in the following questions: 

What is the general effect on the human system of a beverage containing a very low 
percentage of alcohol combined with a large proportion of easily assimilable carbo- 
hydrates and proteins? What is the specific effect of such diluted alcohol so blended 
with neutral matter and in such connection? « 

And we have endeavored to partly answer this question without 
prejudice. But there is one not precisely known factor, yet a signifi- 
cant one, in this problem, and that is the psychopathic diathesis which 
responds so. differently and so harmfully to the fatal sanguine touch 
of alcoholized blood even when impressed in slight proportions upon 
the psychic centers of the brain. 

a The Hospital, February 27, 1909, p. 574. 



PAPERS PRESENTING SPECIAL CAUSES AND CONDI- 
TIONS FAVORABLE TO THE GROWTH OF 
ALCOHOLIC INEBRIETY. 



23 



TOXINS AS ACTIVE CAUSES OF INEBRIETY. 



By G. H. Benton, M. D., Chester, W. Va. t 
Superintendent, Sterling- Worth Sanitarium. 



In pursuing the etiological factors of inebriety we have an ex- 
tremely broad field to cover. While this paper is confined to the 
influence of toxins as an active cause of inebriety we will necessarily 
have to encroach slightly on other facts and factors, at least occa- 
sionally. I shall confine myself largely to the influence of autotoxi- 
cosis, especially to the endogeneous intoxications, and while also 
exogeneous intoxications enter into the etiology, still I am thoroughly 
convinced that they are of secondary importance. 

Primarily we must first turn our attention to the inebriate, and for 
the purposes of this paper we may well divide them into three classes, 
and these three classes we will signify as inebriates from habit drink- 
ing, accidental inebriates, and neuropathic inebriates. Now, a word 
of explanation in reference to these three classes: By habit drinking 
I mean an individual apparently free from hereditary neurosis, one 
who indulges mildly or excessively in alcoholic intoxications and who 
has acute or subacute alcoholism, but who does not exhibit these 
neuropathic degenerations existing before addiction which produce 
an insatiable desire to alcoholic narcosis. These patients are fre- 
quently periodical "spreers," but their symptoms are specifically of 
a diametrical contrast to the dypsomaniac, or more properly alco- 
maniac. These patients, as they will explain to you, have the power, 
if alcoholic drinks are placed before them, to take them or let them 
alone, and while they will most always take them, yet refusal is pos- 
sible within their physical power. 

By " accidental inebriates" I want to signalize a class of individuals 
who fall victims to excessive alcoholic use as it appears through 
accidental means — environment, education, in either early or late 
life, and social indulgences — who begin the use of alcohol moderately 
as beer, whisky, wines, etc., and also the habitual patent medicine 
users, and who may or may not even in their own minds question the 
possible results seriously, but who have, nevertheless, apparently 
good constitutions, good physiques, but in whose condition there can 
be demonstrated at least slight neuropathogenesis. It is not neces- 
sarily shown whether this neuronic degeneration may be congenital 
or acquired, as apparently healthy individuals early in life do not come 
under the close scrutiny of a careful, observing physician detailing 
the actual physical status. Mild, inherent, or acquired pathogenesis 
may either be unnoticed or overlooked in fairly healthy individuals 
who apply for minor incidental treatment. 



26 THE. ALCOHOLIC PROBLEM. 

This second class of inebriates who, when they have reached the 
stage of alarming alcoholic excess, and even after it is somewhat 
prolonged, may still be curable, debarring, of course, the influence 
of intercurrent organic lesions which obtain in such cases. The first 
variety, the habit drinkers, are almost invariably readily curable, 
and are a class of people who very seldom relapse, while you may 
expect the possibility of relapse in the second class. 

Now, in the third class, the alco-maniacs, we have to deal with the 
hardest form of inebriety and a form dependent upon the actual sub- 
jective and many times varied neurosis. This class is recruited from 
the congenital neurotics, I think, without exception. They are aug- 
mented from the geniuses, the precocious, the progressive, and the 
aggressive members of society, who frequently possess an especially 
acute mentality, and are sometimes only term inebriates. I have now 
in my mind a case whose period of inebriety appeared about once in 
seven years and lasted from six weeks to three months, and another 
who had but three attacks during life ; the first attack lasted nearly 
three years, an intermission of twenty-one years between the first and 
second attacks, and finally succumbing during the third attack. 

Now, in the study of autotoxicosis and its influence on inebriety it 
becomes simply a matter of physical and neuro degeneration and the 
reaction is apparent through the central nervous system; consequently 
my investigations of the influence of autotoxicosis on nervous and 
mental diseases within the past year have convinced me, as I find that 
many authorities have been convinced previously, that a careful 
study of inebriety discloses the fact of a disordered nervous system in 
many more cases than we find either environment, education, or 
viciousness; consequently, when we have considered the effect of 
autotoxicosis on the nervous system and on mental diseases we are in 
a position to easily graft on the result, in hundreds of cases, namely, 
inebriety. The inebriate, when he has reached this stage, namely, 
uncontrollable desire for alcoholic narcosis, is not a normal individual, 
functional or organic degenerations are demonstrable, which affect 
especially, both directly and indirectly, the central nervous system. 
These degenerations and functional changes do not entirely come 
from alcohol alone; many of them existed during longer or shorter 
intervals prior to the use of alcohol and are dependent upon both 
hereditary and acquired neurosis, all of which are aggravated and 
prolonged by the use of alcohol. 

Starting an apparently normal individual in life, with faulty habits 
of mastication, lack of rational exercise, an unproportionate amount 
of mental work, an irrational amount of sleep, and the other hundred 
and one incidents of faulty living, which are as common as sunshine, 
and we can easily realize how soon he ceases to be a normal individual 
while long before he realizes it or can be impressed with the fact he 
has generated within his system functional or perhaps organic lesions, 
the progress of which soon demands a narcotic which will produce 
relief from the continual irritation of neuro-toxicosis. This is the 
course of the individual who starts life with seemingly normal resist- 
ance; but just conceive for one moment the condition of the defective 
individual who begins life with unequal advantages, the number 
whose defense lines, weakened from congenital neuroses, being sub- 
mitted to the same or similar conditions which continually Surround 
all of us, and the conflagration is only more rapid. 



THE ALCOHOLIC PROBLEM. 27 

Now, we have an intermediate class who present no congenital 
defects but who easily succumb to the influence of autotoxicosis, 
which eventually produces an inebriate purely through degenera- 
tions of the physical being and through the central nervous system; 
therefore, let us turn our attention to the effects of autotoxicosis on 
nervous and mental conditions. In autotoxicosis we may include all 
the endogenous intoxications; first of metabolic order, under which 
we recognize a condition of perversion of the normal physiological 
function produced by either an excess or deficiency of the normal 
metabolic constituents, and these constituents not only include the 
primary materials of nutrition and metabolism but also the physio- 
logical fluids and secretions associated with and elaborated in the 
process of anabolism andkatabolism. These intoxications of perverted 
metabolism induce a large range of attitudes within the physical 
economy more or less responsible, both primarily and secondarily, for 
the larger range of physical symptoms and disease from which human- 
ity suffers, exclusive, of course, of external accidents and some surgical 
maladies, but nevertheless complicating many times the latter to a 
serious degree; secondarily and also primarily by its influence in 
reducing normal vitality and weakening or destroying the normal 
defense lines of resistance. 

Endogenous metabolic intoxications embrace numerous subdi- 
visions to which we may well direct our attention, the primary func- 
tion of which is oxidation, which may in turn be divided into insuffi- 
ciency of oxygen, suboxidation, and superoxidation. 

Distoxication and overexertion also follow, while retention intoxi- 
cations cover the toxemias produced by retention of bile, perspira- 
tion, faeces, carbon dioxide, and the suppression of urine. 

Intoxications from salts, acids, alkalies, and acidosis. 

Intoxications from fevers, infection, and neoplasms. 

Intoxications due to the perversions of protein metabolism, giving 
expressions in cystinuria, alkaptonuria, and uraemia. 

The perverted nuclein metabolisms producing gout and oxyluria. 

The perverted metabolisms of the carbohydrate group : 

Metabolism of fats: Acetone complex (glycosuria and diabetes). 

Diseases of special organs: Thyroid, adrenal, pituary bodies, pan- 
creas, liver, etc. 

And the second order, parasitic intoxications, embracing both sys- 
temic and alimentary intoxications; the former covering infectious 
diseases and the latter due to bacterial processes and also to the higher 
parasites as vermes. This second order of intoxications or para itic 
intoxications is endogenous, exhibiting intimate relations to and with 
metabolic intoxications, and evidence is at hand showing that it is 
proper to assume that in the larger percentage of the infectious dis- 
eases, the major part of the deleterious results which accrue is result- 
ant from the autotoxicosis secondary to the metabolism of the bacteria 
and does not necessarily bear any relation to the specific poison of the 
particular micro-organism representing the infection. Since in many 
instances no other intoxication is apparent, we are led to believe that 
some micro-organisms are solely harmful through exciting an auto- 
intoxication which is of the nature of accelerations or exaggerations 
of normal processes, katabolism, oxidation, and cystolysis. Exag- 
gerations of katabolism and oxidation which are concurrent in the 
infectious diseases express a distortion of metabolic balance, with 



28 THE ALCOHOLIC PROBLEM. 

which you are familiar; also the acceleration of cystolysis as com- 
monly observed in infectious diseases. 

It is impossible and unnecessary in a paper of this length to go 
into the technic of the processes producing or affecting the large 
range of auto-intoxications which are daily expanding their virulence 
on the anatomical constituents of the physical economy, producing, 
or at least influencing, morbid pathological changes or perverting 
normal physical functions, resulting in varied degrees of invalidism, 
from the slight acute indispositions to the profound organic changes, 
yet your daily observation must confirm the results of the careful 
study of our pathologists, biologists, and chemists who are daily 
seeking and demonstrating the processes through which these auto- 
intoxications are generated and elaborated within the system. And 
while much confusion still exists as to exact processes of production 
and actual extent of damages incurred within and upon the physical 
entity and its functions, yet sufficient evidence has accumulated and 
demonstrations are numerous within our daily observations to prove 
the dangerous aspect of autotoxicosis, and yet I believe they are 
continually underestimated or their relative importance is overlooked 
in calculating the etiology of diseased conditions present, and espe- 
cially in relation to gastrointestinal autotoxicosis. 

The trend of modern living suggests the most extensive possibilities 
in producing gastrointestinal autotoxicosis by the rapidity with 
which we eat without proper mastication of our food, thereby con- 
suming larger quantities of food than the system demands or can 
use properly; in the selecting of improper food, either of kind or 
quantity or quality, and irrational preparation of same; perversions 
of appetite; the attempt to digest large meals when the brain is 
actively engaged in study, business cares, mental anguish, or worry. 
Good digestion requires the termination of the excess of blood to the 
stomach and intestines; active cerebration also requires the termina- 
tion of the blood to the brain; and as both can not be adequately 
supplied at the same time, one or the other process must suffer some 
depression, which is usually first expressed actually as a disordered 
digestion, and finally through the nervous system — toxins formed 
primarily and secondarily within the gastrointestinal tract and 
elaborated through the system. The nervous system, both pe- 
ripheral and central, will show the results, which may express them- 
selves in every degree of divergence from mild acute functional dis- 
turbances to chronic organic lesions. 

I have referred to me frequently nervous and mild mental cases and 
functional diversions whose etiology express primary autotoxicosis 
of gastro-intestinal origin without other complications, and who 
clear up readily through eliminatory processes and the correction of 
faulty habits upon which the primary trouble existed — cases who 
do not relapse excepting through their own indiscretions of diet, etc. 
However, the effect of autotoxicosis through bad hygiene and diet, 
faulty mastication, or other causes, though minimal in amount in 
each instance, but more or less continual, will show marked degrees 
of first physicological diversion, then physical perversion, and even- 
tually pathological entities, which leaves its impact on the nervous 
system. 

Demonstrations of the effect of autotoxicosis on the nervous 
system are observed in varied degrees, as expressed in the following 



THE ALCOHOLIC PROBLEM. 29 

conditions: Migraine, neuritis, epilepsy, myasthenia, melancholia, 
dementia, paralytica, periodiac, family paralysis, constipation, 
nervous dyspepsia, tetany, pain, vomiting, diarrhea, fever, etc. 

Stuertz reports a severe case of autointoxication of intestinal origin, 
with loss of consciousness, dilatation of pupils, clonic convulsions, 
pupils insensible to light, slight trismus, increase of skin and tendon 
reflexes, rise of temperature, slight albuminuria, and a large amount 
of indican, but with absence of aceton or diacetic acid; after entrance 
to the hospital the pulse fell to 52 and eventually to 42. This brady- 
cardia lasted for twelve days. The treatment, which consisted of 
calomel and colonic flushings, was successful. 

Dr. C. A. Herter, New York, through his careful clinical experience, 
backed by equally careful and persistent chemical and bacteriological 
research, has recently published a monograph under the title of 
" Infantilism from chronic intestinal infection," and cites five cases — 
children whose growth and development was checked by intestinal 
autotoxicosis — in which he demonstrates an intolerance of carbohy- 
drates, and his study of the fecal flora shows that the normal gram- 
negative bacilli and cocci are replaced by gram-positive bacilli, one 
of which, bacilli infantilis, is regarded as having an etiological relation 
to disease. The process shows considerable loss of fat in the stool, which, 
combined with the restriction of carbohydrates, results in a condition 
of undernutrition. This accounts for the lack of development of the 
tissues in general, and again the diminished absorption of fats has a 
further detrimental aspect by withdrawing the alkaline substances, 
calcium and magnesium, in the formation of soaps. Thus deprived of 
its mineral constituents, the skeleton fails to develop. 

This condition is found to be chronic, the bacilli have firmly estab- 
lished themselves by long habitation, having first become implanted 
during acute or subacute gastroenteritis in early infancy. 

Autotoxicosis of gastrointestinal origin is undoubtedly of the 
most common occurrence, and it is more than probable that no 
individual ever existed without incurring one or more attacks, while 
the rule is that the larger majority of individuals suffer more or less 
continually with recurrent attacks, and many of them with such 
frequent recurrences as to express a condition of continual toxicosis 
which, perhaps, began with transitory or acute auto-intoxications, but 
in the wake of its rapid repetition and continuance induced the other 
metabolic perversions including any or many of the endogenous 
intoxications, with especial predilection for one or more of the reten- 
tion intoxications. Representing a class of cases who consult their 
physician with no special organic lesions but whose physical func- 
tions are perverted and distorted that it sometimes is puzzling to 
decide where to begin to establish normal physical function. This 
class of cases, which present themselves in a condition of a more or 
less chronic toxicosis, also represent varied conditions of functional 
or even the more grave forms of nervous manifestations or even 
actual phychosis, while the cases who have begun thus and failed 
either partially or fully to follow the advice of their physician as to 
propholasis and treatment, and who have developed organic lesions 
either of the central or peripheral nervous system, or both, usually 
allow themselves to succumb to any intrinsic or extrinsic intoxica- 
tions which present themselves, either intrinsic auto-intoxications 
over which they have no further control or from extrinsic intoxica- 



30 THE ALCOHOLIC PROBLEM. 

tions under the guise of medication through the hope of relief from 
the distressing symptoms of their maladies until they eventually 
produce drug neurosis in the varied degrees of inebriety. 

Autotoxicosis produces marked degrees of effects on the peripheral 
nerves, both in their trunks and endings in the muscles, but in a much 
lesser degree than is witnessed in the nerve centers owing to the more 
intense metabulism through the freer vascular supply, the nerve 
centers are seats of much greater activity and are exposed thereby 
to the injurious influences of effete material, which may be circulating 
in the blood current. The ratio of the difference of this effect is pro- 
posed as one to five. 

The results recognized from the effects of autotoxicosis upon the 
nervous system may be both mediate and immediate, both trophic and 
toxic, and just here I wish to call your special attention to more recent 
investigations by our leading neurologists in reference to the relation- 
ship of arterio-sclerosis and diseases of the nervous system and also 
some references to the recent studies on the influence of circulating 
toxins on the production of arterio-sclerosis. The older theory that 
arterio-sclerosis was incumbent on hypertention is gradually being 
abandoned as the cause, although it may or may not be concomitant 
with the diseased condition of the arteries. 

The present acceptation of the disease resulting from the investiga- 
tions of Van Noorder, Klemperer, and others, demonstrates that the 
primary irritation is due to toxic materials circulating in the blood. 

It has long been apparent that alcohol, rheumatism, malaria, 
typhoid fever, and such diseases have been productive of arterio- 
sclerosis, and omitting all the long explanations demonstrating the 
immediate process producing this condition, which are conclusive, I 
will refer only to one, the production of arterio-sclerosis by the use 
of adrenalin chloride as demonstrated in experiments upon rabbits 
and other animals, conducted in such a manner as to show that the 
changes in the blood vessels were due to the toxic principle rather 
than from hypertention. The experiments of T. Mironescu (3) 
Therapeutische Monatshefte, January, 1906, were conducted on 
rabbits, in which he neutralized the constrictor action of adrenalin 
by a simultaneous administration of euphthalmin, there was pro- 
duced thereby calcification of the aorta from which was concluded 
that the degenerative changes were due to direct toxic action of the 
adrenalin on the vessel walls, the variations of blood pressure being 
only subsidary. 

In the present era arterio-sclerosis is recognized as much more 
common and extensive than formerly conceived or at least taught. 
From our twentieth century fury of high speed tension emploj^ed in 
modern business life, and a large range of other contributing causes, 
there may exist much more extensive lesions of this kind, and again 
with our modern technic and instruments of precision we may be 
more capable of early and frequent recognition. Then, again, the 
hereditary factor may be traced, due perhaps to inherited perverted 
structures of the blood vessels, which render them more susceptible 
to accident and injury. At any rate, it is a diseased condition which 
we may recognize much more frequently, also its results in the influ- 
ence and production of nervous and mental diseases, the importance 
of which has steadily been growing in the minds of neurologists until 
it appears that in the diagnosis, prognosis, and treatment of nearly 



THE ALCOHOLIC PKOBLEM. 31 

every chronic nervous disease, either functional or organic, the ques- 
tion of the existence of arterio-sclerosis must be dealt with. 

The position arterio-sclerosis formerly occupied in relation to 
senility and old age, which has been assigned it by our predecessors, 
has advanced during the present generation to manifestations of the 
commonest sequence of a strenuous, disordered, irrational mode of 
our modern life. 

In conclusion let me refer to the studies of Dr. J. Collins (New York 
Medical Journal, June 9, 16, 23, 1906) of the relationship of arterio- 
sclerosis and diseases of the nervous system based on 800 cases in 
which the diagnosis of arterio-sclerosis was definitely made, taken 
from the records of 10,000 consecutive cases of nervous disease, in 
which he says arterio-sclerosis may cause (1) diseases of the nervous 
system that are well-defined clinical entities, and are therefore de- 
scribed as definite diseases; (2) it may superimpose definite or indefi- 
nite symptoms upon any disease, incidentally altering the clinical 
feature of the disease; (3) it may give rise to symptoms which are so 
dispartate that it is difficult to group them under any one heading, 
hence they are therefore often considered to be functional, neurasthei, 
or hysterical; and (4) it may cause symptoms almost identical with 
those of well-known diseases. The desirability of early diagnosis in 
arterio-sclerosis is the greater because of what would seem to be the 
fact that in its incipiency the pathological processes may be checked, 
but the difficulty of early diagnosis may be very great and, regrettably, 
the diagnosis must still often be empirical, vessels susceptible of 
examination, manual or instrumental, may be free from perceivable 
sclerosis while others inaccessible are well advanced in the process 
which is productive of symptoms. 

In the 800 cases above referred to there were 206 patients suffering 
from disorders of the nervous system, directly attributable to this 
cause, in which the symptoms varied from slight vertigo to the most 
profound dementia, and between these two extremes one might find 
almost any kind of subjective and objective disturbance — paralysis, 
aphasia, hemianopsia, emotional upheavals, bulbar, and spinal 
symptoms of every sort; and, further, Collins has observed many 
times a clinical form of cerebral arterio-sclerosis, heretofore inade- 
quately described, and has studied the lesions after death. A fugitive 
occipital headache, slight dizziness, feeling of insecurity of station, and 
impaired snap and vitality go to make up the picture. Sometimes 
there are early emotional manifestations — attacks of meaningless 
laughter, less often of crying, not coming on spasmodically, as in 
multiple sclerosis and old apoplectic cases, but, nevertheless, like them, 
by reason of having no attributable cause and being without emo- 
tional concomitant. 

The most striking feature of the disease is the alteration of the 
patient's appearance. The individual becomes transformed from a 
person expressing grace in movement and relaxation in repose into 
an immobile, inanimate replica of the normal person. 

The immobilization gives a more or less characteristic gait and 
attitude, which is remarkable; the stride is short, feet widely sepa- 
rated, and often the patient runs better than he walks. The knee 
jerk is usually lively, and in some cases Babinski's sign is present. 

Death may come from syncope, intercranial hemorrhage, or from 
trifling intercurrent disease. Pathological examination may show 



32 THE ALCOHOLIC PEOBLEM. 

the brain normal or shrunken. The vessels at the base may be 
atheromatous or not, and sometimes the only striking alterations 
are in the middle cerebral arteries and their branches. Collins had 
15 cases and 5 autopsies. 

The chief manifestations that cerebral arterio-sclerosis produce 
aside from the symptom-complex above described are: (1) Insomnia 
and dyspnoea; (2) headache and cephalic paresthesia; (3) vertigo; 
(4) brain tumor symptom-complex; (5) neuresthenic symptom-com- 
plex; (6) epilepsy, focal and general; (7) amnesia and dementia; 
and (8) apoplectic symptoms. 

Now, realizing the extent and possible range of physiological 
perversion and neurological degenerations arising from the more 
or less chronic course of our too habitual autotoxicosis, and our 
knowledge of the etiology and pathogenesis of inebriety, it is impos- 
sible to the fully demonstrated fact of cause and effect, between 
toxins and inebriety. The neurotic, whether the neurosis be of 
hereditary origin or induced, is compelled to perform his daily duties 
under the stress of continual nervous irritation, and he soon learns 
that alcohol or the other narcotic drugs through their paralyzing 
effect produces a feeling of comfort, never realizing, however, the 
danger of the remedy; his irritation is so uncomfortable and so con- 
tinual that he even is induced to run exceptional risks to secure that 
desired relief, believing fully that he is an exception to the usual 
individual and can stand the test, or many more times has no con- 
ception whatever of the danger of the remedy, and, further, is unable 
to picture himself as a possible inebriate until it is too late; once 
started the conflagration proceeds in exact proportion to the kind of 
fuel which has been prepared for it through autotoxicosis mainly. 



ALCOHOL AS AN ADULTERANT IN FOODS AND DRUGS. 



By Prof. H. W. Wiley, 
Chemist to Government Department of Agriculture, Washington, D. C. 



Fortunately alcohol is not used very extensively as an adulterant 
in foods aside from its presence in alcoholic beverages. It is true that 
occasionally makers of confectionery have placed alcohol in confec- 
tions, but this is positively forbidden at the present time by the food 
and drugs act, which makes it a criminal offense to put alcohol in 
any form into confections. Alcohol instead of brandy, unfortunately, 
is sometimes used in preserving peaches under the name of "brandied 
peaches," but this I believe is not a very common offense. 

I wish to speak to you chiefly, however, respecting the use of alcohol 
as an adulterant in beverages containing alcohol. There are three 
great classes of alcoholic beverages. First, fermented beverages, 
such as wine, beer, and cider; second, distilled beverages, such as 
whisky, brandy, and rum; and third, mixed drinks of all kinds con- 
taining alcohol as one of their constituents. What I have to say 
to-day relates particularly to these mixed drinks. It is well known 
that alcohol per se is a poisonous substance, and hence produces 
intoxication. I may say that no refined taste ever drinks alcohol as a 
beverage. You can not find it sold over the bars in any saloon, 
perhaps, in this city. Even those who are addicted to the alcohol 
habit prefer a beverage containing alcohol as one of its ingredients to 
the pure article. There are some drinkers of alcohol, however, who 
like to have it straight — as, for instance, those who drink vodka in 
Russia, and other drinkers of pure alcohol in northern Europe. The 
habit has not extended, however, to this country except as it has been 
brought in by some of the emigrants from northern Europe. The 
great bane in the use of alcoholic stimulants to-day is in the mixed 
drinks, such as cocktails, absinthes, and other mixed articles. It is in 
this form that it produces its most deadly effects. 

I shall speak to you particularly about absinthe, because not only 
does it contain alcohol pure and simple, but also a number of extracts 
from herbs which are of a highly injurious character. The absinthe 
plant itself furnishes the extract which gives the beverage its name, but 
in addition to absinthe, hyssop, fennel, poisonous sage, and some other 
plants are used. This group of bodies used in absinthe produces to 
those who are addicted to their use convulsions of an epileptiform 
character. This is not a true epilepsy but an epileptiform kind of 
convulsion, resembling that of true epilepsy, but of course of a tran- 
sient character, passing off as the drug spends its power. Taken 
singly or together they are bad enough, but when mixed with alcohol 

«. Doc. 48, 61-1 3 33 



34 THE ALCOHOLIC PROBLEM. 

their effect is more pronounced. The sale and manufacture of 
absinthe have been forbidden in Belgium and Switzerland. In the 
latter country prohibition has not yet gone into effect, but has been 
voted. In France the effects of the use of absinthe have been 
studied by learned commissions for a number of years, and as a result 
of these studies the French Government has strictly regulated the 
manufacture and sale of absinthe in that country, and there is a serious 
contemplation of the desirability of forbidding it altogether. For- 
tunately, the use of absinthe has not spread to any very great extent 
in this country, and let us hope that steps may be taken to prevent 
any additional use of it, or even that it may be stopped altogether. 
Under the food and drugs act it appears to me that the importation 
of absinthe from a foreign country may be prohibited, and I am at 
work at the present time on a report, to be presented to the Secretary 
of Agriculture, in which I shall base my recommendations for pro- 
hibition, just as smoking opium was prohibited under the food and 
drugs act. This is one of a very bad type of drinks of this kind 
which should be restricted or prohibited. 

There are other drinks which also demand attention as well as 
alcohol, and among those I may mention the secret use of caffeine. 
You will find in the report of the President's home commission almost 
one hundred preparations containing caffeine which are designed to 
be sold at soda fountains. Thus it often happens that parents who 
do not permit their children to use coffee and tea in the home are 
allowing them to use caffeine in its most injurious form at the drug 
stores. In my opinion the use of caffeine in so-called "soft drinks'' 
should be prohibited because of its highly injurious effect, especially 
upon the organism of the child. This is a question, however, which 
I shall leave to be discussed by one of my assistants, Doctor Kebler, 
who has made a special investigation of this matter. 

The evils which come from the secret use of drugs are well known. 
Some of them are bad enough when they are used openly, and they 
are all reprehensible when administered without the knowledge of 
the victim. In my opinion the greater part of the evils against which 
the propaganda of prohibition is waging war would be entirely elim- 
inated by the prohibition of the use of alcohol in its pure form in any 
kind of a drink or mixture, and if alcoholic liquors are to be used at 
all they should be confined to those pure, old, and mellow, in which 
nature modifies the injurious properties of the alcohol by many 
forms of combination. It should be the part of all good citizens to 
aid at least in the war against alcohol used as an adulterant in foods 
and drinks. 



ALCOHOL AND ITS INFLUENCE ON PULMONARY TUBER- 
CULOSIS. 



By Dr. H. J. Achard, Asheville, N. C. 



It is but natural that in a disease so widely distributed as is pul- 
monary tuberculosis, and so intimately connected with the social 
question, so called, in all its different view points, the attention of 
physicians, sanitarians, and sociologists alike should have been 
drawn to the interrelation of the disease with others, whose more or 
less serious effects on the body political require the careful attention 
and consideration of political economists and of public workers. 
One of the most fruitful sources of the social evil, to which the 
" white plague" contributes its full share, is undoubtedly the abuse 
of spirituous liquors or chronic alcoholism, and its connection with 
the causative factors of pulmonary consumption has been the subject 
of much discussion and experiment. I propose in the following 
pages to review the opinions held on the subject in times gone by, 
then to give the physiological data concerning the action of alcohol 
upon the organism, data upon which the right of the drug to be 
considered as a valuable therapeutic agent has wrongly been based, 
and finally to relate some of the experimental investigations which 
have been made with a view of elucidating and eventually settling 
the question at issue. It is of course impossible to consider the 
literature pertaining to the subject at all completely, nor is such a 
course necessarv, since much has been told and retold, much is 

J 7 7 

irrelevant, and, moreover, it can not be within the province of a 
journal article to repeat in detail the controversies and investigations 
which have led to the acceptation of a certain hypothesis or theory. 
While the Ayur-Veda of Susruta, 1 the ancient medical codex of the 
Hindu, recommends alcohol in the treatment of consumption, declar- 
ing that distilled spirits remove consumption, it is silent on the ques- 
tion whether the abuse of alcohol contributes to the origin of the dis- 
ease. Hippocrates 2 likewise does not enumerate alcoholism among 
the causes of consumption, but recommends the use of old, tart, red 
wine in small amounts to consumptives. Celsus, 3 on the other hand, 
held that wine was harmful to those afflicted with the disease. Of 
the writers of the middle ages and of more modern times, most authori- 
ties acknowledge the injurious effect of excesses of every kind, espe- 
cially those in baccho et venere, for the origin and in the course of 
phthisis. So includes Richard Morton, 4 who may, after Sylvius, be 
called the first great "phthisiographer," the " excessive ingestion of 
wine and strong spirituous drinks" among the causes of "original 
pulmonary consumption," and is confirmed by Boerhaave. 5 Didelot 8 
said in 1780 that phthisis, which was very frequent in the Vosges, 

35 



36 THE ALCOHOLIC PROBLEM. 

killed there many peasants addicted to the use of spirits, and de 
Brieude 7 declared that drunkenness among the people of the Auvergne, 
and especially among the women, whose passion for wine and spirits 
he calls incredible, was one of the principal causes of consumption. 
Benjamin Rush, 8 too, already in the first edition of his Medical Inquir- 
ies (1789) called attention to the increase of consumption in the 
United States, together with the increasing intemperance and seden- 
tary modes of life. Wichelhausen, 9 who carefully differentiates what 
he calls the " slimy" from the other forms of consumption (phthisis 
pituitosa) considered the immoderate use of heating drinks, especially 
wine and spirits, as one of the most frequent "occasional" or acci- 
dental causes of the disease (1806). He asserts that the many per- 
sons who succumb to the disease in the later years of life are commonly 
immoderate drinkers, and brings the fact that in early life more 
females than males die of the disease, while in later life the reverse is 
true, into relation to the abuse of spirituous drinks among men. 
Papavoine explained the unfavorable action of alcohol by the increas- 
ing debility of the system which it causes, and Schoenlein l0 called it 
pernicious for the same reason. Sir James Clark 11 considered the 
abuse of spirituous liquors among the lower classes in England pro- 
ductive of consumption and other tuberculous diseases to an extent 
far beyond what is usually imagined. 

Toward the middle of the last century, however, a different opinion 
began to make itself felt, and strangely enough it originated in our 
own country. Dr. J. B. S. Jackson 12 had rarely observed phthisis 
among drunkards; out of 35 alcoholics only 5 were found tuberculous 
on autopsy, and of these only 2 had died of phthisis. Doctor Peters 13 
had, in the bodies of nearly 70 persons dying suddenly or found dead 
in the streets and who had been known as alcoholics, detected not a 
single instance of actively softening tubercle, and only a few cases 
of chalky tubercle or cicatrices surrounded by little numerous tubercle. 
He inferred that alcoholism exerts a prophylactic influence against 
the formation of tubercle. Doctor Washington u asserted by deduc- 
tive reasoning that, since phthisis has its origin in deficient respiratory 
action, the use of alcohol will overcome the defect by causing a more 
rapid breathing. Kubik 15 in Prag also failed to find tuberculosis in 
any of his autopsies on persons dead of delirium tremens. But it 
was especially due to Magnus Huss, 16 whose work on Alcoholismus 
Chronicus (1849) made him an acknowledged authority on this 
disease, that a tendency declared itself to assume an actual antago- 
nism between alcoholism and phthisis. Having found tubercle arrested 
in their development in autopsies on alcoholics, he attributed the 
result to the alcoholism and advocated on that account the use of 
alcohol in the treatment of consumption. By so doing he caused 
alcohol to become a popular remedy, and although physicians have 
long since been convinced of the fallacy of the prophylactic value of 
alcohol against consumption, and have come to learn that the drug 
is a two-edged sword and only to be used for clearly denned cases, 
the popular error is not, to this day, eradicated. 

These erroneous ideas which, without sufficient scientific founda- 
tion, have invaded medical science were emphatically attacked and 
shown to be errors, in our own country, first by Dr. John Bell, 17 of 
New York (1859). In his essay which received the prize of the 
Fiske fund from the Rhode Island Medical Society he found it 



THE ALCOHOLIC PKOBLEM. 37 

" difficult to imagine how so widespread a belief could have arisen 
from so few recorded facts." Two theories, he says, as to the causes 
of the deposition of tubercle in the lungs from each of which the 
utility of alcohol as a therapeutic agent has been inferred, have been 
extensively circulated in the medical journals. The first of these is a 
chemical one. It supposes that the tissues of the body, and partic- 
ularly of the lungs, are too rapidly oxidized, and accordingly that 
alcohol, like cod-liver oil, might supply the fuel for this abnormal 
combustion, and thus prevent a continual waste if not supply mate- 
rial itself. The other theory is a mechanical one, and attributes the 
origin of tubercle to a deficient circulation of the blood, and a conse- 
quent retrograde metamorphosis of the tissues. In this hypothesis, 
too, alcohol is the remedy, by increasing the action of the heart. 
These theories have undoubtedly assisted in giving currency to the 
prevailing opinion, viz, that alcohol is favorable in phthisis and 
antagonistic to it. 

From a careful and extensive statistical study, which we can not 
give here, even in abstract, it " seems almost conclusive that the use 
of alcohol not only has no power to defend those predisposed to 
phthisis from its attacks but would, with little doubt, change the 
predisposition into actual disease." 

The work of Bell was confirmed by Dr. N. S. Davis 18 in a report to 
the American Medical Association (I860). From careful notes on 
210 cases of consumption he found that 68 had been habitual users of 
alcoholic liquors for from one to twelve years before their disease 
first manifested itself, though only 15 of these could be called " drunk- 
ards;" 91 had used such drinks occasionally, and 51 had abstained 
wholly. The average duration of the disease from its first signs to 
the fatal termination was in the three classes of patients nineteen, 
twenty-three, and twenty-five months, respectively. Doctor Davis 
claimed that the use of alcoholic beverages neither prevents the devel- 
opment of tuberculous phthisis, nor retards the rapidity of its prog- 
ress. In fact, by impairing " metamorphosis " (metabolism) and 
elimination, it facilitates the development of tuberculous disease. 

Needless to say, the conclusions promulgated by Bell and Davis 
were not at once accepted by physicians. Doctor Walshe, 19 while 
refusing to pronounce a decided opinion on the influence of alcoholism, 
thinks that " publicans, who unquestionably as a class consume 
their own vendibles, are ceteris paribus less destroyed by phthisis 
than persons in various other walks of life." Leudet, 20 too, found 
among 295 drunkards only 37 cases of pulmonary tuberculosis, and 
held that abuse of alcohol does not hasten death from tuberculosis; 
in fact, he observed that in potators the disease took a more chronic 
course than in other persons, although on the other hand he acknowl- 
edged the deleterious action of alcohol in its causation of hepatic 
cirrhosis. Rose 21 found frequently indurated tuberculous areas in 
the lung apices of alcoholics, and to a higher degree than miliary 
tubercle. Koranyi 22 finally claimed that the ability of alcohol to 
influence directly the pathological process in the tuberculous lung can 
not be denied. This influence is, according to him, probably a con- 
nective tissue hyperplasia in the lungs. He was only recently con- 
firmed by Hammer, 23 who concluded from the findings in three 
autopsies on phthisical potators, where enormous connective tissue 
thickening was found around the tuberculous foci, that alcohol 



38 <£' THE ALCOHOLIC PKOBLEM. 

stimulates connective tissue* proliferation, and that it thus may 
become a healing factor, 

One oJL the foremost opponents of alcohol, since the reports of Bell 
and Davis, was Professor Lancereaux, 24 of Paris. The abuse of spir- 
ituous liquors, according to him, contributes greatly to the develop- 
ment of one of the most acute forms of phthisis, the acute miliary 
phthisis. He explained the undeniable influence of alcoholism upon 
the occurrence of tuberculous peritonitis by the irritation caused by 
alcohol through the portal vein in its entire territory, and considers 
this fact to be the probable reason of the great frequency of tuberculous 
peritonitis in persons over forty years of age. "Every physician/' 
he exclaims, in his "Lecon de clinique medicale" (1879-1891), "who 
will take the trouble to follow up the cases of alcoholism, as I have 
done for a long time, will infallibly realize that the majority of these 

Eatients become consumptives." Spirituous drinks act, according to 
lancereaux, in two ways, causing a malnutrition by diminishing the 
appetite, and a pulmonary irritation in the course of their elimination. 

Herard and Cornil, 25 in the first edition of their work on pulmonary 
phthisis, as well as in the second, published with the collaboration of 
Hanot, could not agree with Magnus Huss and Leudet regarding the 
antagonistic influence, if any, of alcohol; they collected histories of 
a number of consumptives in whom the disease evidently commenced 
after the immoderate use of alcoholic beverages. In several cases the 
course of the disease was rapid. 

In the annual report of the Massachusetts State Board of Health 
(1873), Doctor Bowditch 26 gave the result of an inquiry made among 
210 physicians regarding the predisposing action or alcohol to tuber- 
culosis. Of the 210, 109 replied afTirmatively, 47 negatively, and 13 
were noncommittal. 

Dr. Horace Dobell, 27 whose peculiar and withal ingenious ideas on 
the origin of tuberculous phthisis are well known, found a ready 
explanation, which fits beautifully into his etiological system of the 
disease. Attributing, as he does, tuberculosis to an insufficient action 
of the pancreas, the influence of alcohol would be exerted as follows: 
A form of hydrocarbon is thrown into the circulation through the 
portal system which substitutes the normal supply of fats by the 
lacteal system. The affinity of oxygen for alcohol being greater than 
its affinity for fat, respiration is supplied from this artificial source 
with carbon for direct combustion; an artificial nutrition is kept up, 
in which the natural call for fat is stopped, and the function of the 
pancreas is reduced to supplying the minimum quantity necessary 
for histogenetic purposes. To this inactivity of the organ is added 
the usual tendency to degeneration due to alcoholism. In course of 
time the pancreas loses that minimum amount of function which it 
had been allowed to exert, and fails to supply even so much fat as 
was necessary to protect the albuminoid tissues, and tuberculosis 
results. Or, as frequently happens, the toper ceases to obtain his 
supply of alcohol, either from inability to get it or from inability to 
absorb it or retain it on the stomach. His artificial supply of carbon, 
upon which he has been depending, is thus cut off, a sudden call is 
made upon the pancreas for that which it has now lost the power to 
give, the tissues are disintegrated in order to supply the required fat 
elements, and tubercle is produced. 



THE ALCOHOLIC PEOBLEM. ' 39 

The Doctors Williams, 28 who have certainly had an unusually ex- 
tensive experience with consumptives, from their connection with 
the Brompton Hospital for Consumptives, have no hesitation in 
assigning a large amount of phthisis to the predisposing cause of 
alcohol, "in spite of Doctor Walshe and other eminent authorities." 
They add, "it is extraordinary how easily in the lungs of a toper the 
tuberculous masses break down and how rapid the course of the dis- 
ease proves." 

Pidoux 29 attempted to reconcile the two opposing opinions on the 
influence of alcohol. Believing that alcoholism is a cause of phthisis, 
he nevertheless held that it is also one of the factors which are antago- 
nistic to the disease. The reason lies in the fact that alcoholism 
varies in different people. In sanguinous, vigorous, well-nourished 
persons it produces an effect more or less analogous to gout, car- 
buncle, abdominal plethora, hypersecretion of uric acid, etc., creating 
antagonistic rather than favoring conditions for the development of 
phthisis. In feeble, badly nourished persons who drink bad wine 
to excess, phthisis is, on the other hand, frequent. 

More recently Amat 30 and Thorain, 31 both inspired by the opinions 
of their teacher, Professor Lancereaux, have reviewed the question 
under consideration. According to Amat, it is to-day admitted by 
almost everybody that by his excessive drinking the drunkard be- 
comes only too often a preferred candidate for pulmonary tubercu- 
losis. But he goes further, and maintains that the alcoholic origin 
imprints upon the tuberculous disease a peculiar character by which 
it differs from phthisis of other origin. Thorain, who, like Amat, 
relates a series of case histories of alcoholic consumption, finds that 
alcoholism is far from exerting a preserving or therapeutic action 
against tuberculosis, but contributes manifestly to its development, 
by causing alterations in the organs, by debilitating the system. 
For Dr. S. Bernheim 32 the abuse of alcohol favors the breaking out 
of tuberculosis. It has been noted, he says, that in France consump- 
tion increases in a parallel rate with alcoholism. The effect of alcohol 
is due to its weakening action on the organism. This effect is evi- 
dently the proper explanation of the predisposing action of alcohol, 
and may occur from various other preceding diseases, such as anaemia, 
diabetes, and acute infections (Gottstein 33 ). This weakening effect is 
accepted to-day by the foremost clinicians as undoubted; still, the 
idea carried to an illogical conclusion is objected to, for instance, by 
Martius, 34 who strongly condemns the extreme view of Legrain pro- 
nounced at the Ninth International Congress against Alcoholism, in 
Bremen, 1903, to the effect that tuberculosis occurs exclusively on 
the foundation of alcoholism. Legrain even went so far as to de- 
mand that the funds which are used for the struggle against tubercu- 
losis be deviated from that purpose and employed for the struggle 
against alcoholism, because with its removal the problem of tuber- 
culosis would also find its solution. 

My former teacher, Prof. G. v. Bunge 35 in Basel has for years 
investigated the deleterious effects of alcohol upon the animal organ- 
ism and sees in it the cause for a great many ills. In the last edition 
of his text-book on physiology he says it can not be denied that a 
predisposition to disease is inherited, and that this predisposition 
may be acquired on the part of the parents by an abnormal mode of 
living, especially through alcoholic and other poisoning. Espina y 



40 THE ALCOHOLIC PROBLEM. 

Capo S6 declared before the Paris Congress on Tuberculosis, in 1905, 
that alcoholism and tuberculosis form the worst possible combination, 
that every alcoholic is a candidate for tuberculosis. Reynier 37 has 
been struck by the observation that in external tuberculosis occurring 
after the fortieth year of life, the abuse of alcohol is frequently the 
only predisposing factor which can be ascertained, and that in such 
cases all history of family taint is generally absent. Crothers 38 
quite recently demonstrated in a study of 100 cases of alcoholism that 
it lowers the vitality and resistance, and predisposes to consump- 
tion, and Cornet 39 explains the favoring influence of alcohol on the 
development of pulmonary phthisis thus, that the ciliated epithelial 
cells are, by alcohol, temporarily weakened and paralyzed, so that 
one important defensive provision against the inhalation of tubercle 
bacilli is rendered inactive. Another harmful consequence he sees 
in the weakening of the heart muscle. 

The general conviction thus prevails that alcoholism is distinctly a 
predisposing factor for the acquirement of tuberculosis, by virtue of 
its enfeebling, paralyzing effect on the defensive apparatus of the 
organism and the general systemic resistance to infectious diseases. 
For centuries it has been realized that everything which disturbs the 
strength of the organism and interferes with nutrition predisposes to 
phthisis, and it is undoubtedly this result of chronic alcohol poison- 
ing which lessens the resistance to infection. We may fittingly con- 
clude this literary study with the words of Prof. S. Adolphus Knopf, 40 
in his article on "Tuberculosis" (Twentieth Century Practice, 1900, 
vol. 20, p. 187): 

That alcoholism is one of the greatest direct and indirect causes that prepare the 
field for the tubercle bacilli is now generally conceded, not only by physicians and 
sanitarians, but also by all sociologists who have studied the question. It is not only 
a phthisiogenetic disease par excellence in adult life, but, according to statistics care- 
fully kept in some of the European hospitals for scrofulous children, in more than 
50 per cent of the cases either the father or the mother, or both, were found to be or 
to have been alcoholics. 

In the subsequent chapter we shall find these ideas justified by experiment. 

The following authors have been consulted in the preparation of 
this study in the original unless otherwise designated : 

1. Susruta. The Ayur-Veda, after Hessler's Latin transl., 1844-1850, cited by 
Miqueu-Rey, These de Paris, 1905. 

2. Hippokrates. De morbis internis., translated into German by Rob. Fuchs. 
Miinchen, 1897, volume 2, page 495. 

3. Celsus. Lib. IV, cap. 4, p. 205, cited by Van Swieten, Comment, in Hermanni 
Boerhaave Aphorismos. Parisiis, 1765, volume 4, page 39. 

4. Morton, Rich. Phthisiologia. Francofurti et Lipsiae, 1691, Lib. II, cap. 1, 
page 79. 

5. Boerhaave, Herm. Instit. medic, 1721, cited after Thorain (1. c. No. 31). 

6. Didelot. Hist. d. 1. Soc. roy. d. med. d. Paris, volume 2, 1780, page 13, cited 
after Amat (1. c. No. 30). 

7. de Brieude. Mem. d. 1. Soc. roy. d. med. Paris, 1782-83, page 316, cited ibid. 

8. Rush, Benj. Medical Inquiries and Observations. Philadelphia, 1789, 2d ed., 
1805, volume 1, page 200. 

9. Wichelhausen, E. Ueber die Erkenntnis, Verhuetung und Heilung der 
schleimigen Lungensucht. Mannheim und Heidelberg, 1806, page 149. 

9a. Papavoine. Propositions sur les tubercules, 1830, cited by Thorain (1. c. No. 31). 

10. Schoenlein, J. L. Allgemeine und specielle Pathologie und Therapie, 2. 
Aufl., Wuerzburg, volume 3. 1832, page 123. 

11. Clark, Sir James. A Treatise on Pulmonary Consumption. Philadelphia, 
1835, page 179. 

12. Jackson, J. B. S. New England Quarterly Journal of Medicine and Surgery, 
cited by Bell (1. c. No. 17). 



THE ALCOHOLIC PROBLEM. 41 

13. Peters. New York Journal of Medicine, 1844, cited by Walshe (1. c. No. 19). 

14. Washington. Nashville Journal of Medicine and Surgery, 1856, cf. Bell (1. c. 
No. 17). 

15. Kubik. Vierteljhrschr. f. Prakt. Med., volume 1, 1846, page 39. (Ref. un- 
known.) 

16. Huss, Magnus. Alcoholismus chronicus. Stockholm, 1849, cited by Amat 
(1. c. No. 30). 

17. Bell, J. American Journal of Medical Sciences, n. s., volume 38, October, 1859, 
page 407. 

18. Davis, N. S. Transactions American Medical Association, volume 13, 1860, 
page 565. 

19. Walshe, W. H. A Practical Treatise on the Diseases of the Lungs. London, 
1860, page 513. 

20. Leudet. Clinique Medicale. Paris, 1874, cf. Schmidt's Jahrb., volume 163, 
1874, page 219. 

21. Rose. Deutsche Chirurgie. Stuttgart, 1884, page 66. (Ref. unknown.) 

22. von Koranyi. Eulenburg's Realencyclopaedie d. ges. Heilk. Wien and 
Leipzig, volume 12, 1887, page 240. 

23. Hammer. Prag. Med. W T chnschr., 1901, No. 26, cf. Schlueter, Die Anlage zur 
Tuberkulose. Leipzig and Wien, 1905, page 249. 

24. Lancereux. Diet. Dechambre, cf. Herard, Cornil et Hanot (1. c. No. 25). 
See also Amat (1. c. No. 30). 

25. Herard et Cornil. La Phtisie pulmonaire. Paris, 1886, 2d 6d. with Hanot, 
Paris, 1888, page 347. 

26. Bowditch. Annual Report Massachusetts State Board of Health, 1873. 

27. Dobell, Horace. On the loss of weight, blood spitting, and lung disease. 
London, 1878, page 199. 

28. Williams, C. J. B. and Ch. Th. Pulmonary Consumption. 2d ed., London, 
1887, page 84. 

29. Pidoux. Cf. Herard, Cornil et Hanot (1. c. No. 25, page 366). 

30. Amat. L. These de Paris, 1893. 

31. Thorain, J. These de Paris, 1894. 

32. Bernheim, S. La Tuberculose. Paris, 1903, page 51. 

33. Gottstein. Aetiologie, in Schroeder und Blumenfeld, Therapie der chron. 
Lungenschwindsucht. Leipzig, 1904, page 64. 

34. Martius, Fr. Die Prophylaxe der Tuberculose. Ibid., page 104. 

35. von Bunge, G. Lehrbuch der Physiologie des Menschen. 2. AufL, Leipzig, 
volume 1, 1905, page 388. 

36. Espina y Capo. Congres International d. 1. Tuberculose. Paris, 1905, volume 2, 
1906, page 775. 

37. Reynier, P. Bull. Acad. d. Med., 3 e , ser., volume 88, 1907, page 407. 

38. Crothers. Gaillard's South Med., volume 82, 1907, page 53. 

39. Cornet. Die Tuberkulose. 2. AufL, Wien, 1907, page 498. 

40. Knopf, S. Ad. .Twentieth Century Practice of Medicine. New York, 1900, 
volume 20, page 187. 



ALCOHOL AND ITS INFLUENCE ON PUBLIC HEALTH. 



By George W. Webster, M. D., 
President Illinois State Board oj Health. 



Good health with length of years is the greatest asset of the indi- 
vidual and of the nation. It follows that the state as well as the 
individual is, or should be, vitally concerned in all that pertains to 
the welfare of the individual. There is no such thing as public wel- 
fare without public health. On the other hand, there is no commodity 
of which civilization has been and is so wasteful as of human life. I 
do not hesitate to say that it is my opinion that the alcohol problem 
is, from a moral, ethical, sociologic, scientific, economic, medical, and 
public health point of view, one of the most vitally important unsolved 
problems of the world to-day; and the public health phase of the 
question is not the least important. It is to-day perhaps the most 
baffling and serious obstacle in the way of man's progress toward a 
higher evolution. 

The alcohol problem is intimately and intricately interwoven with 
our whole modern life, with politics, with the industries, with gov- 
ernment revenue; but I shall speak chiefly from the public health 
side of the question. 

I can not do better than quote from the very able address of Prof. 
W. T. Sedgwick in the annual address in medicine at Yale University 
last year. He said, 1 in speaking of the alcohol problem: 

When one considers in detail the relations of alcoholic indulgence to disease, the 
numerous and important ailments of which it is the direct cause, to say nothing of 
the indirect influence on human misery and degeneracy, one can hardly avoid real- 
izing that it stands almost, if not altogether, in the front rank of the enemies to be 
combated in the battle for health. 

I believe that the prevention of alcoholism, which is a preventable 
disease, the prevention of individual and national deterioration 
through its injurious effects, comes as much within the sphere of 
action of the medical health officer as tuberculosis or smallpox. I 
believe that any preventable disease which has a distinct bearing on 
individual efficiency and national progress comes clearly within the 
duty of the public health officer. 

To understand the alcohol problem fairly, in all its bearings, it 
should be viewed in the light of history which clearly shows that moral- 
ists, fanatics, empirics, and even physicians and psychologists, have 
experimented in well-meant ignorance, fettered as they were by lim- 
ited scientific knowledge and "shackeled by the dead hands of igno- 
rance and authority." 

42 



THE ALCOHOLIC PROBLEM. 43 

We must consider it as a biologic problem, as a medico-sociologic 
problem; the latter simply as a part of that great medico-sociologic 
problem which is concerned in a comprehensive study of the nature, 
action, and reaction of man and his environment, all based upon a 
sound pathologic foundation. 

It must be viewed from the standpoint of the trained psychologist, 
and investigated in accordance with his modern laboratory methods. 

The alcohol problem should be viewed as but a part of the large 
public health problem in which it is now quite generally recognized that 
the most valuable, effective means of coping with an evil consists in 
the concentration of all available agencies energetically upon its 
prevention. 

We should attack the problem in accordance with the principles 
and practices and the spirit of modern scientific research, and should 
then attempt to apply this knowledge to measures of practical reform. 
Public health is receiving a greater degree of attention than ever 
before, from the President, from sanitarians and health officers, and 
from the people, through an enlightened public-health sentiment. 
"If, in this great forward general movement for sanitary reform and 
public-health work, we ignore the alcohol problem, it will leave a 
great gap in our line of battle." 

In order to gain a better idea of the importance of the problem, let 
us discuss briefly its cost to the nation; its influence upon infectious 
diseases; its death rate, and its influence upon the general efficiency 
of the individual. 

It is impossible to accurately estimate the cost of alcohol to the 
people of the United States. However, some of the items can be 
stated with reasonable accuracy. 

It is estimated that 50 per cent of municipal expenditures for the 
maintenance of police departments is for the arrest of the intoxicated 
portion of the population. Add to this the cost of trial, conviction, 
and maintenance of convicted persons in jails, penitentiaries, etc. 

It is estimated that 20 per cent of the insane owe their insanity 
directly or indirectly to alcohol, and there are probably at least 
150,000 insane persons in the United States, cared for at public 
expense. Assuming that 20 per cent of these owe their insanity to 
alcohol, and that McDonald's estimate of $400 is the loss per person 
per annum to the State, we have for this one item alone the sum of 
$12,000,000. This corresponds exactly with the estimate of Dr. 
Frederick Peterson. 2 

Add to the foregoing the loss of time of those convicted of crime, 
the loss of time while intoxicated, or while recovering from its effects. 

The Census Bureau reports show that the liquor and beverage 
industries are capitalized at $534,000,000, and 5 per cent of this 
means an annual cost of $26,700,000. 

The consumption of alcoholic liquors in the United States in the 
year 1907, amounted to 2,019,690,911 gallons, 3 a per capita con- 
sumption of 23.53 gallons as against 17.68 in 1900, and Mr. Powers, 
chief statistician for agriculture, estimates that the amount spent 
for the above is from $1,000,000,000 to $1,200,000,000 per annum. 

Prof. Irving Fisher, in his paper read before Section V of the Con- 
gress on Tuberculosis at Washington, D. C, 1908, estimates the 
annual death rate from tuberculosis in the United States at 138,000, 



44 THE ALCOHOLIC PROBLEM. 

and he also estimates the money cost including capitalized earning 
power lost by death, to exceed $8,000 per death. 

Assuming that the death rate from alcohol is as great as from 
tuberculosis (and I shall try to show that this is a fair assumption), 
then the annual cost to the United States in amount lost by death 
is at least $1,004,000,000. Adding these four items and leaving 
out the large amount of municipal expenditures, and we have the 
enormous total of $2,142,700,000. This would give over $15,000 
to the family of every one of the 138,000 persons dying annually 
of tuberculosis in the United States. 

The total direct and indirect cost of Great Britain's drinking is 
estimated 9 at $1,750,000,000. 

MORTALITY. 

Our mortality statistics of alcoholism are very incomplete, owing to 
the fact that probably few physicians put down the cause of death as 
alcohol, even though they know it to be the cause. Out of consider- 
ation for the feelings of the family, alcoholic gastritis is put down as 
chronic gastritis. Alcoholic cirrhosis of the liver is simply cirrhosis of 
the liver, alcoholic insanity as insanity, and alcoholic nephritis as 
Bright 7 s disease. 

Probably Switzerland and Denmark are the only countries in the 
world in which the returns are reasonably accurate, the reason being 
that they are the only countries of Europe in which the secret medical 
is guaranteed, and the death certificate is not seen by the relatives. 

Fernet of Paris 4 estimates that alcohol is the principal or sole cause 
of 10.2 of the total mortality, and is the adjuvant or accessory cause of 
23.60 per cent additional. Among the insane it is the cause of 50 per 
cent of the mortality. 

Crothers 5 estimates that alcohol is the direct and indirect cause of 
from 10 to 20 per cent of all deaths. 

In estimating the mortality from alcohol, it is necessary to take 
into consideration its influences in favoring the occurrence of probably 
all infections and their greatly increased mortality under its use. 
For example, Dr. Robert H. Babcock estimates the death rate of pneu- 
monia among alcoholics as 50 per cent. In addition to these we must 
take into consideration many permanently diseased conditions due to 
progressive alterations that take place in tissues as a result of the 
change in their metabolism due to alcohol. Sir Victor Horsley's list 6 
of these diseases is as follows : 

Diseases due to alcohol alone: Acute alcoholic poisoning, acute 
mania, delirium tremens, chronic alcoholic insanity, alcoholic epilepsy, 
alcoholic neuritis. 

Diseases of which alcohol is frequently a determining or a con- 
tributing cause: Pharyngitis, gastritis, chronic dyspepsia, dilatation 
of the stomach, congestion of the liver, cirrhosis of the liver, fatty 
liver, chronic Bright's disease, gout, glycosuria, obesity, congestion 
and overgrowth of glands and skin, functional disorders of the 
ovaries and breasts leading to a sterility and inability of mothers to 
suckle their infants at the breast, dilatation of the heart, fatty heart, 
arteriosclerosis, increased susceptibility to inflammatory diseases of 
the eyes, inflammation and degeneration of nerve structures, including 



THE ALCOHOLIC PROBLEM. 45 

the optic nerve, epilepsy, melancholia, dementia, imbecility, hysteria, 
idiocy, and sunstroke. 

If we add to the foregoing the deaths from accidents due to alcohol , 
the infant mortality due to alcoholism among the mothers, the prema- 
ture deaths due to alcoholism, 7 Tt is very easy to believe that the 
estimate that 10 per cent of all mortality is due to alcohol is a very 
reasonable one. 

It has been shown 8 that in Great Britain from 25 to 51 per cent of 
total poverty is due to intemperance. Poverty is one of the main 
causes of premature sickness and death. 

ALCOHOL AND LIFE EXPECTANCY. 

Arthur Newsholme, 10 in the chapter on " Alcohol and public 
health," after reviewing the experience of the United Kingdom" Tem- 
perance and General Provident Institution, from 1849 onward, in 
which the recorded experience concerned 31.776 whole life policies of 
nonabstainers, passing through a period of 466,942 years of life, and 
29,094 whole life policies of abstainers, passing through 398,010 years 
of life, and after showing the greater life expectancy of the latter 
he says : 

In alcoholism we have to deal with a chief cause of national inefficiency. This 
inefficiency is partly caused by the sickness and mortality due to alcoholism, and the 
numerous diseases which it favors, or actually produces, including insanity. Alco- 
holism is a chief cause, if not actually the chief cause of poverty. The evil really 
wrought by alcoholism is much greater than any official figures reveal. 

ALCOHOL AND MENTAL WORK. 

At the meeting of the British Association for the Advancement of 
Science, 11 it was the " unanimous agreement that alcohol, even in the 
smallest amounts, is deleterious to the quality of mental work." 

Among people of average neuropsychic equilibrium, the exact 
large number of individuals in whom alcohol, when taken even in 
moderate doses, brings to light, often with a startling rapidity, their 
latent defect. This marked intolerance of alcohol is exhibited by 
the epileptic, the imbecile, and the degenerate. To the neuropathic 
and psycopathic, to the hereditarily burdened, it is pregnant with 
disaster. 

EFFECT UPON FATIGUE AND ENDURANCE. 

Speaking on this subject, Sir Frederick Treves, in the course of an 
address delivered at Westminster, London, said: 

I was with the relief column that moved on to Ladysmith. It was an extremely 
trying time apart from the heat and the weather. In that column of 30,000 men, 
the first who dropped out were not the tall men, nor the short men, but the drinkers, 
and they dropped out as clearly as if they had been labeled with a big letter on their 
backs. 

Dr. W. H. R. Rivers, in the Croonian lectures delivered at the 
Royal College of Physicians in 1906, on " The influence of alcohol and 
other drugs on fatigue/' after reviewing the immediate effects of 
alcohol upon muscular work, says: 

In observations which have been made on large masses of men in campaigns, etc., 
the results point strongly to the conclusion that alcohol is prejudicial to the capacity 
for work and in no way helps to diminish the effects of fatigue. 



46 THE ALCOHOLIC PROBLEM. 

The work of Hellsten 12 is the most extensive that has been done 
on the action of alcohol, and seems to clearly prove the injurious 
influence of alcohol on the capacity for muscular work. 

Professor AschafTenburg has demonstrated 13 that in such work as 
typesetting, and where the experiments were carried out with all the 
rigor of psychological methods, there is an average loss of working 
efficiency of 10 per cent. All of the men who took part in the tests 
admitted that after Sunday indulgence they found Monday's work 
more difficult and they made more mistakes on that day. 

Major Blackham, of the British army, in a recent paper 14 before 
the army and navy section of the British Medical Association on the 
subject of "The feeding of the soldier/' concludes that "alcohol is 
unnecessary in any form or in any quantity, under any circumstances 
that may occur in military affairs." He restricts these observations 
to the healthy man. 

Lieut. Col. Edmond Monkhouse Wilson, of the British army, in 
his president's address 15 before the navy, army, and ambulance sec- 
tion of the British Medical Association, July 30, 1908, in speaking of 
alcohol in the services, says: "Exertion of the body is better borne 
without than with alcohol; this has been proved most conclusively." 
He quotes Schneider, the German observer, who examined 1,200 
mountain climbers and found that "as long as continuous efforts and 
difficulties are to be expected, no alcohol should be taken." 

He says further: 

In the^ exposures and fatigues of war it has been demonstrated that alcohol is quite 
unnecessary to enable troops to support them effectively and cheerfully; nor are 
they endured any better when alcohol is consumed, but, on the contrary, worse. 

After describing military campaigns which include the extremes of 
heat and cold and of malarious climates, in which he says the bodily 
exertions of the troops were "extreme," he further says: 

All prove that very great exertion and exposure to extremes of temperature can 
be better borne without alcohol than with it. As to great cold, opinion is unanimous 
among the well informed; all alcohol is more or less hurtful. The experience of 
arctic voyagers and Alpine guides is singularly concordant as to this. As to great 
heat, the evidence is equally conclusive. 

On all these points Maj. G. S. Crawford 16 is in entire and emphatic 
accord. 

ALCOHOL AND THE ACUTE INFECTIONS. 

One of the most important phases of this problem is the influence 
of alcohol upon susceptibility to infection and upon the course of the 
infectious process, once it is started. It seems to be clearly estab- 
lished that alcohol when used experimentally destroys the resisting 
power of the animal to germs. 

Prof. William H. Welch 17 summarizes the action of alcohol as 
follows : 

Alcoholic intoxication increases the susceptibility of animals to many infections, 
and influences unfavorably the process of immunization. Pregnant rabbits repeatedly 
intoxicated by alcohol are likely to abort, and to die soon afterwards from some acci- 
dental infection. Many of their young die a few days after birth. 

Maj. G. S. Crawford, of the British army, says: 18 

Alcohol by its devitalizing action on the tissues of the body renders those who habit- 
ually use it more liable to attacks of various forms of disease. It is one of the strongest 



THE ALCOHOLIC PKOBLEM. 47 

predisposing causes to tuberculosis, and regiments in which the greatest amount of 
alcohol is consumed have the largest percentage of men invalided from this disease. 
Drinkers have less recuperative power after severe injury or operation. 

He further quotes Sir Frederick Treves as saying, "Having spent 
the greater part of my life in operating, I can assure you that the 
person of all others that I dread to see enter the operating theater 
is the drinker." 

Professor MetchnikofT recently demonstrated 19 that alcohol, even 
in small doses, paralyzes the phagocytes and renders them incapable 
of protecting the body against microbic invasion. 

This is in line with the work of Kesteren on the influence of alcohol 
on living protoplasm, and reported in the same journal. He says: 20 

There was absolutely no sign of any stimulating effect. The effect upon them was 
in all cases the same, it being simply a question of the degree of paralysis induced. 

George Rubin 21 has shown that alcohol decreases and finally, in 
1 to 50, suspends phogocytosis completely in vitro, brought about 
probably by some change in, the cell protoplasm. 

Wright's observations have shown 22 that the tuberculo-opsomc 
index is definitely and positively lowered by alcohol. 

The work of Dr. Reid. Hunt, of the United States Hygienic Labora- 
tory, published in February, 1907, shows that even small doses of 
alcohol increases the susceptibility of animals to infectious diseases 
and lowers the vitality of their offspring. 

Prof . T. Laitinen, at the Stockholm International Congress, reported 23 
the results of his experiments and investigations and showed that 
small quantities of alcohol (that is, an amount equal to half a pint 
of 3 J per cent beer for an adult man) lowered the resistance of rabbits 
and guinea pigs to infection. 

ALCOHOL AND TUBERCULOSIS. 

William Ewart, St. George's Hospital, London, says, 24 in speaking 
of this topic: 

I hold with Knopf, who declares that in any stage or form of pulmony tuberculosis 
large quantities of alcohol are contraindicated. In direct opposition to those who 
look to alcohol for an additional element of nutrition, we should dread any such con- 
tribution as a Danaan gift. 

And again: 

The better rule is to keep our patients independent of alcoholic beverages, -even 
at meals. 

The international congress on tuberculosis which met in Paris in 
1905 passed the following resolution: 

That in view of the close connection between alcoholism and tuberculosis, this con- 
gress strongly emphasizes the importance of combining the fight against tuberculosis 
with the struggle against alcoholism. 

As regards resistance to disease, Prof. William H. Welch says : 25 

This lowered resistance is manifested both by increased liability to contract the dis- 
ease and by the greater severity of the disease. 

Sir Victor Horsley says : 26 

In the case of illnesses such as pneumonia and blood poisoning, it is proved that the 
alcohol habit notably diminishes the power of the tissues to resist the invasion by these 
same organisms. 



48 THE ALCOHOLIC PROBLEM. 

In the case of diphtheria, very numerous experiments have shown that alcohol, when 
given to the animal before or after infection to diphtheria, diminishes normal resistance 
of the organism of the animal to infection in a very definite way. 

It has been proved by Doctor Delearde and others that immunity against disease 
can not be obtained so easily by those habituated to the taking of alcohol. For exam- 
ple, he found 27 that alcoholized animals could not be immunized against rabies, "the 
alcoholized animals remaining as susceptible to the disease as if no attempt had been 
made to vaccinate them." 

CONCLUSIONS. 

The alcohol problem is more important than the tuberculosis 
problem as (1) it costs more lives and more money; (2) it costs the 
United States over $2,000,000,000 annually; (3) it probably causes, 
directly and indirectly, at least 10 per cent of all deaths in the United 
States; (4) it predisposes to infection, destroys acquired immunity, 
prevents the occurrence of artificial immunity, at least in rabies, 
lessens resistance, leads to an increased mortality in all infectious 
diseases and after surgical operations; (5) it lessens the power of the 
individual to resist the injurious influences of extreme heat and cold; 
(6) it causes a deterioration of the quality of mental work; (7) it dimin- 
ishes the power to withstand fatigue and lessens the general efficiency 
of the individual; (8) it is a poison and should be classified as such, 
instead of as a food or stimulant; (9) when the physicians take hold 
of the question in the same spirit as they have shown concerning yel- 
low fevers, malaria, and smallpox, instead of treating it as a moral 
question and leaving it to clergymen, temperance workers, and 
enthusiastic reformers, we may expect better results; (10) more may 
be accomplished by teaching the people the truth in regard to the 
fatal effects of alcohol upon mental and physical efficiency than by 
expatiating on the moral wickedness of drinking. 

We deserve condemnation as a profession, when we assume the 
attitude of sneering contempt for the efforts of clergymen, laymen, 
enthusiasts, and reformers in their attempts to stamp out this evil, 
just as we would deserve it if we would assume the same attitude 
toward them if they attempted to stamp out yellow fever and 
malaria. Fortunately, the question is receiving new attention by 
earnest men who have the courage of their convictions and who 
see with clear vision, and who will not be deterred by sneers or 
criticisms. 

Public opinion demands, and has a right to demand, in no uncer- 
tain tones, that the action and influence of alcohol be determined and 
settled by the medical profession, and that we then teach the people 
the truth fully, conscientiously, and fearlessly. 

In closing I can not do better than again quote Prof. W. T. 
Sedgwick, when he says : 

Whatever may be the practices or prejudices of some of its individual members, 
the medical profession should stand for temperance as one great essential of public' 
health. That there has been too much neglect of the matter in the past is all the 
more reason why the profession should do its full duty now and in the future. 

REFERENCES. 

1. Journal A. M. A., September 12, 1908. 

2. New York Medical Journal, December 26, 1908, page 1205. 

3. Personal letter from Dr. Cressy L. Wilbur, chief statistician, United States Census 
Bureau. 

4. Journal A. M. A., volume 49, 1907, page 2171. 

5. Medical Fortnightly, October 25, 1907 f 



THE ALCOHOLIC PKOBLEM. 49 

6. Horseley and Sturge, Alcohol and the Human Body, 1908, pages 298-300. 

7. Virchow's Archiv., Dr. Rudolph Pfister, 1908. 

8. Labor and Drink, John Burns, M. P., London, 1904. 

9. The Drink Problem, T. N. Kellynack, page 4. 

10. The Drink Problem, T. N. Kellynack, page 122. 

11. Journal A. M. A., 1907, page 1371. 

12. Skand. Arch, of Physiol., Bd. XVI, S. 160. 

13. Dr. Henry Smith Williams, McClure's, October, 1908. 

14. Journal A. M. A., August 29, 1908. 

15. British Medical Journal, August 8, 1908. 

16. British Medical Journal, August 8, 1908. 

17. Journal A. M. A., September 9, 1905, page 780. 

18. British Medical Journal, August 8, 1908, page 317. 

19. Quarterly Journal of Inebriety, autumn, 1908, page 195. 

20. Quarterly Journal of Inebriety, autumn, 1908, page 42. 

21. Journal A. M. A., April, 1907, page 1432. 

22. Modern Medicine, Dr. J. H. Kellogg, 1908, page 277. 

23. Journal of Inebriety, spring, 1908, pages 48-49. 

24. Progressive Medicine, Volume VII, September, 1905, page 44. 

25. Physiological Aspects of the Liquor Problem. 

26. Alcohol and the Human Body, 1908, page 289. 

27. Alcohol and the Human Body, 1908. 

S. Doc. 48, 61-1 4 



DYSPEPSIA AND ITS RELATIONS TO INEBRIETY. 



By D. H. Kress, M. D., 
Superintendent Washington, D. C, Sanitarium. 



In a leading editorial which appeared one year ago in a New York 
daily the significant statement was made: " There is no denying the 
fact, we are in the midst of an epidemic of crime." That this epi- 
demic still prevails may be seen by glancing through the columns 
of any one of our daily papers. The headings in a paper I recently 
looked through ran as follows: " Kills employer and self/' " Sup- 
posed suicide under arrest/' "Band terrorizes railway patrons," 
"Secures divorce," " Pastor assassinated," "Believed to have ended 
his life." 

Reports of murder, suicide, divorce, and crime are so common 
that they no longer create alarm. We have in a measure become 
familiar with them, and yet the newspapers of our large cities give 
but a partial and incomplete report of the crimes actually committed. 

It is universally recognized that alcohol is in a great measure 
responsible for this sad social state. 

The evils which to-day are so apparent have proved the ruin of 
nations of the past. It was when Belshazzar, the king, made a 
great feast to a thousand of his lords, and drank wine before the 
thousand, that the words appeared, "Thy kingdom is divided and 
given to the (more temperate) Medes and Persians." These same 
evils brought destruction to the antediluvians. 

"In the days that were before the flood" drunkenness was respon- 
sible for the immorality and the sad social condition that existed. 
"Every imagination of the thoughts of man's heart," we are told, "was 
only evil continually." 

The marriage vow was lightly regarded. The record informs us, 
"They took them wives of all which they chose." 

Corruption prevailed. "The earth also was corrupt, and the earth 
was filled with violence." There evidently existed then, as to-day, 
"an epidemic of crime." 

~ That which inflamed and maddened the minds of men before the 
flood and led them to commit the most unnatural crimes is dethron- 
ing reason to-day, and is almost wholly responsible for our houses of 
prostitution, insane asylums, hospitals, almshouses, prisons, etc. 

Sir Andrew Clark said : 

Out of every 100 patients I have charge of at the London Hospital, 70 per cent 
directly owe their ill health to alcohol. 

According to the testimony of judges who legally sever the matri- 
monial banns in court, "more than two-thirds of the divorces are 
occasioned by the use of intoxicants." 

50 



THE ALCOHOLIC PROBLEM. 51 



One judge says: 



There is not one case in twenty where a man is tried for his life in which alcohol is 
not the direct or indirect cause of the murder. 

A district attorney of Boston declares " ninety-nine out of one 
hundred of the crimes in our Commonwealth are produced by intoxi- 
cating liquors/' 

The Maoris of New Zealand, according to Captain Cook, were, at 
the time when he first visited the island, almost perfect in physique. 
Even the old men, he states, possessed the endurance of youth. 
They numbered then over 120,000. Alcohol and tobacco found their 
way to them as the island became inhabited by the white race. Men, 
women, and children began to drink and smoke, in their innocence 
believing it a blessing. To-day the Maoris are a race of physical and 
moral degenerates, numbering only 41,000. 

Chief Justice Stout, of New Zealand, in passing sentence upon a 
drunken Maori a few years ago, said: 

If this drink is not stopped among the Maoris we are in measurable distance of the 
time when the Maori race, the noblest race with which civilization has been brought 
in contact, will be exterminated. 

The same results are witnessed among other races. In speaking of 
the Hawaiians, a Honolulu paper, in an editorial, contained the 
statement : 

There are now living men of voting age who will witness the death of the last 
full-blooded Hawaiian. 

Sad are the results of tobacco and alcohol on these races. Some 
attribute the probable extermination of these races to their immo- 
rality, but fail to recognize alcohol as the cause of the immorality that 
is manifested. 

The decreasing birth rate in civilized lands finds a partial explana- 
tion in the prevalent use of alcoholic beverages. The number of 
children born in these countries to-day does not suffice to continue 
these races. France shows a shortage of births of over 19,000 during 
the year 1907 — that is, the death rate exceeds the birth rate by this 
number. Professor Cattell, in taking the census among the poor of 
New York, in 22 apartment houses found only 54 children distrib- 
uted among 485 families — that is, 1 child to every 9 families. Among 
the upper classes a similar condition exists. He states that "the 
Harvard graduate has on an average seven-tenths of a son" and "the 
Vassar graduate has one-half of a daughter." This lowering in births 
may in part be attributed to preventive measures, but among the 
Maoris no preventive measures are employed, and yet the same con- 
dition exists. The diminished birth rate among them is due chiefly 
to a loss of reproductive power, resulting from alcoholic degeneracy. 

While all are more or less familiar with the results of alcoholism, 
few have inquired into or are familiar with the physical causes which 
are responsible for the free use of alcohol. 

Why do men and women desire alcohol? There is nothing desirable 
about the taste. It does not appeal to the palate. It is a significant 
fact that of all creatures that exist man alone possesses a craving for 
strong drink, and among mankind the craving is well-nigh universal. 

Some, after learning the deceptive nature of alcohol, and the evils 
which it is responsible for, have sufficient will power to regulate, 
or abstain altogether from, its use. Others, knowing all this, satisfy 
the craving at any cost; among these we find the mental defectives. 



52 THE ALCOHOLIC PROBLEM. 

The fact that nearly all inebriates give clear evidence of being 
mentally defective has led to the conclusion by scientists that only 
mental defectives become inebriates. 

This forces upon us the question, Why do we have in our midst 
so many mental defectives? Alcohol is known to be a disturber of 
the functions of muscular activity, of mental energy, of the circu- 
latory system, and in fact of the function of every cell of the body. 
At first it produces irritation, which may be mistaken for stimula- 
tion. Later, when absorbed by the living cells, it deadens and 
slows their activity. It deadens the mind so that one is unable 
to decern between the sacred and the common; between right and 
wrong. The weakness in the animal nature becomes manifest. It 
awakes the sleeping lion of heredity. 

Prof. C. F. Hodge, of Clark University, to ascertain its influence 
upon the brain and disposition, gave alcohol to two kittens, with 
very striking results. In beginning the experiment, he says, it was 
remarkable how quickly and completely all the higher psychic char- 
acteristics of both the kittens ." dropped out." Playfulness, purring, 
cleanliness and care of the coat, interest in mice, fear of dogs, while 
normally developed before the experiment began, all disappeared 
so suddenly that it could hardly be explained otherwise than as a 
direct influence of the alcohol upon the higher centers of the brain. 

Continued functional disturbances of this character in any organ 
will in time bring about structural changes of the organ. We are 
well aware that continued disturbance of the circulation in time puts 
a permanent stamp upon the blood vessels and the heart; and that the 
liver and kidneys of the drinker undergo organic changes of a serious 
nature. Continued disturbances of the brain also leaves an indelible 
and permanent record on the tissues of the brain. These mental 
defects are transmitted from parent to children. For this reason 
the mental defectives are usually found among those whose parents 
have been users of narcotics, and especially of alcohol. 

It is not necessary for parents to drink to excess in order to be- 
queath such an inheritance to their offspring. In fact, occasional 
sprees afford an opportunity between times for the establishment 
of a normal condition and are therefore not so injurious either to 
parents or their posterity as the continued use of alcohol in small 
doses. Brain degeneracy to some extent exists in every child born 
of alcohol-using parents. In the second generation of alcohol users 
the degeneracy becomes more manifest, while as a rule it remains 
for the third or fourth generation to reap the full result of alcoholism. 
Doctor Joffrey says : 

Alcoholism, begins with the father and strikes down the children, and generally 
its action continues until in the fourth or fifth generation it has destroyed the family. 

The efforts put forth by temperance workers has proved a benefit 
to the moderate drinker; to those who have sufficient mental power 
to exercise restraint and avoid drink after knowing its influence, but 
it has failed to reach the class that need help most — the mental 
degenerate who lacks the power to do what he knows to be right. 

If inebriety is due to structural brain changes, is there any help for 
the inebriate? While I could not take the position that all are 
curable, from my experience in the treatment of these cases during 
the past twenty years I am convinced that even advanced cases of 
inebriety should not always be regarded as hopeless. Many of. them 



THE ALCOHOLIC PROBLEM. 53 

can be cured by proper treatment, providing they can be kept under 
treatment a sufficient length of time. The treatment should, how- 
ever, be directed chiefly toward the removal of the craving for drink, 
for without this craving the mental defective is as secure against the 
use of alcohol as the one who has no such defect. 

Dietetic errors I believe to be largely responsible for the craving 
for alcohol and indirectly therefore for the results of alcoholism. If 
this is so, reforms must begin in the home. 

In describing the causes of violence which filled the earth in the 
time of the flood it is stated, "They were eating and drinking, marry- 
ing and given in marriage." One naturally followed and was the 
outgrowth of the other. Errors in eating were responsible for the 
use of strong drink, and strong drink was the cause of domestic 
unhappiness, divorce, and crime. 

A person who is a mental defective and possesses this craving may 
pass through life without ascertaining what he craves, but the first 
glass may be sufficient to make him a slave to drink, after having 
discovered it is alcohol he craves, or he may become a slave of some 
other drug or patent medicine. 

A woman in Liverpool, who was an inebriate, said to me: 

My doctor recommended me to take some ale after giving birth to my second child; 
from the time I took the first drink, although I did not like the taste of it, there has 
been present a craving for it which I can not resist. I often go past a saloon as rapidly 
as I can only to return and enter, and when one drink has been taken all self-control 
is gone. 

She was desirous of doing right, but was evidently one in whom 
there existed a peculiar mental weakness. She would have been safe 
from drink even though this mental disease existed did she not in 
addition possess a craving for strong drink, a craving which she was 
no doubt unconsciously cultivating in her home by what she ate and 
drank at her table. It was not until she took the beer prescribed by 
her physician that she became conscious of what her system craved, 
and being once conscious of it, the weakened will was unable to deny 
the craving. 

I remember hearing one of England's leading temperance lecturers 
say, at a public gathering, she had great sympathy for the woman 
who is a slave to beer, "Because," she said, " although it is fifteen 
years since I touched it, I still possess the same desire for it I did then." 
At the time I thought this remark a very strange one to be made by an 
advocate of temperance. 

Recently I heard a noted American temperance lecturer say: 

No man or woman in this audience is fonder of the taste of cocktails and wine than I 
am. The taste has been handed down to me, but I hate the stuff. 

In what respect do these temperance advocates differ from their 
more unfortunate sister? In common with her they possessed a 
craving for drink, but while they were mentally well balanced their 
more unfortunate sister was not. Although she, too, may "hate the 
stuff," she takes it just the same. 

Could we enter the homes of these lecturers on temperance and note 
what they eat and drink at their meals, we should probably find the 
explanation of their craving for narcotics. 

The saloon keepers have by experience and observation been 
taught that certain foods create an unnatural irritation or thirst that 
water can not quench. They keep a lunch counter for their patrons 



54 THE ALCOHOLIC PEOBLEM. 

not because they have compassion on the unfortunate poor. If it 
was an act of pure benevolence on their part, we would expect them 
to feed not merely the drunkard, but the drunkard's wife and children. 
With them it is a matter of business. The secret of the free lunch 
table we may discover by taking an inventory of the food that is found 
upon it. It is not laden with juicy peaches, pears, oranges, etc. 
They know that such foods would ruin their business. We find upon 
this table sausages, pickled pigs feet, smoked ham, mustard, pepper, and 
other irritating products. Experience has taught the saloon keeper 
that these things create a thirst which calls for alcohol, and therefore 
it aids him in culling out his victims — the mentally defective. 

The sad feature about this is, many a good wife and mother is 
supplying her husband and sons with the same kind of food that is 
found on the table in the saloon, and is thus unconsciously cultivating 
in the members of her family a craving which leads to the open saloon 
door. 

The poor drunkard, who, when admonished to straighten up and be 
a man, said, a You good people have a great deal to say about my 
drink, but you have nothing to say about my thirst, " could no doubt 
be classed as a mental defective, yet this man realized that if it was 
not for his insatiable thirst he would experience little difficulty in 
giving up drink. 

None too much has been said about the evils of strong drink and 
the need of doing away with the saloons which afford such an alluring 
temptation to those who crave drink and are mentally weak, but the 
time has come when, if physicians, temperance advocates, and lovers 
of humanity would accomplish their ends, something more must be 
said in regard to the unnatural thirst these poor drunkards have and 
how it may be gotten rid of. For, after all, it is this thirst and not the 
existing mental defect that makes the inebriate. 

I believe with Dr. Lawder Brunton that schools of scientific cookery 
conducted for the benefit of the wives and mothers of the laboring 
classes would do more to abolish strong drink and to close our saloons 
than any number of teetotal societies, for as long as the craving for 
drink exists, the mental defectives will satisfy it, if not with alcohol, 
with some drug perhaps more injurious. This has been demonstrated 
repeatedly. In France they resort to absinthe; in the South where 
alcoholic beverages are prohibited the use of cocaine and other drugs 
is becoming almost universal among the negroes. 

Since we can not of a certainty determine in whom and to what 
extent this mental defect exists until weeded out by the saloon, it is 
right that the saloon should be closed to all in order to protect the 
weak, but with the closing of the saloon there should be carried for- 
ward an educational effort pertaining to diet. 

Flesh foods served so abundantly at our modern tables are respon- 
sible for much of the craving which causes drunkenness. For this 
reason, in countries where flesh foods are freely used, alcohol is also 
freely resorted to. Alcohol antidotes for a short period the effect of 
the uric acid taken with the flesh. Uric acid, caffeine, and theine act 
as irritants, and thus call for a narcotic to deaden the unpleasant sen- 
sation. Again, the uncomfortable feeling resulting from the high 
blood pressure produced by meats, can temporarily be removed by 
lowering the blood pressure by the use of alcohol. For the meat eater 
to keep comfortable, however, it will be necessary for him to keep in a 
mild state of alcoholic intoxication all the time. The prevalent use 



THE ALCOHOLIC PKOBLEM. 55 

of meat is therefore without doubt responsible in part for the free use 
of alcohol, and for this reason alcohol and meat eating are so intimately 
associated. 

Professor Ganthier, by carefully conducted experiments covering a 
period of many years for the purpose of ascertaining the influence of 
various foods upon the disposition of animals, discovered that he 
could change their disposition by changing the nature of their food. 
White rats, as long as they were fed on breads and grains, were very 
gentle, but when given flesh to eat they became quarrelsome and 
destructive. This is no doubt partially due to the local irritation 
caused by the excessive production of a highly acid gastric juice 
resulting from the glandular stimulation of the uric acid and other 
wastes found in the meat, and partially by the direct influence of the 
urates and other unoxidized wastes upon the sympathetic nervous 
system when absorbed. Ganthier's conclusion is that "a flesh diet 
is a more important factor in determining a savage or violent dispo- 
sition in any individual than the race to which he belongs.' ' We 
may probably have here an explanation why families, and often mem- 
bers of the same family, differ so widely in disposition and why some 
are given to drink while others are not. It would certainly be of 
interest in studying this matter to note the foods each is especially 
fond of. Why should not the experiments which have been so suc- 
cessfully conducted in laboratories, by scientists upon animals, be 
carried into the home? Should this be done, we would probably 
appreciate the need of having intelligent and scientific cooks instead 
of trusting so important a matter as the preparation of foods to the 
most ignorant and illiterate class, as we now do. 

Dr. Baron Liebig said: 

The ingestion of flesh produces in carnivorous races a ferocious and quarrelsome 
disposition, which distinguishes them from nonmeat eaters. 

There can be no doubt that the products in meat which tend to 
make men ferocious and quarrelsome by the excitation which they 

Eroduce also pave the way for strong drink, and that, other things 
eing equal, the more flesh a man consumes the greater will be his 
craving for narcotics, and the more serious will be his danger of 
becoming a drunkard. 

Even among the ancients the intimate relation existing between 
the consumption of flesh and drunkenness was observed. The 
admonition is given, u Be not among wine-bibbers; among riotous 
eaters of flesh.' ' And again, mention is made of a class who were 
" slaying oxen, killing sheep, eating flesh, and drinking wine." 

Daniel's strength of mind to refuse the wine served at Babylon's 
royal table may be in part attributed to the nature of the food of 
his choice. Daniel was evidently accustomed to a fleshless and 
simple diet; therefore when commanded to eat at the king's table he 
" purposed in his heart he would not defile himself with the king's 
meat nor with the wine," but said, "Let them give us pulse to eat, 
and water to drink." There was a natural association between 
Babylon's meat and their wine, while the food which Daniel chose 
demanded no stronger drink than water. 

We have here the reason why, in order to elevate the Israelites 
physically and morally, they were taken away from the fleshpots of 
Egypt and were given instead of meat manna to eat and water out 
of the rock for their thirst. In this lies the hope of elevating the 



56 THE ALCOHOLIC PROBLEM. 

people of to-day physically and morally, for it is only in this way 
that we shall succeed in getting rid of strong drink and its results. 

At the beginning man was placed in a garden and surrounded with 
trees pleasant to the sight and good for food. The command was, 
"Of every tree thou mayest freely eat." Had man always continued 
to freely eat of fruits, and to live on the simple foods to which his 
attention was then directed, strong drink would probably be unknown, 
for it is impossible for anyone to cultivate a taste for fruits and a 
craving for strong drink at the same time, and, furthermore, it is 
impossible for even an inebriate, unless he is an utter degenerate, 
to live on these simple foods exclusively for six months without 
losing his craving for strong drink. On this point the editor of 
the London Clarion some time ago related his experience, in an 
editorial. He said: 

I have just turned vegetarian. My friends are surprised; so am I. But whereas 
they are surprised that I have adopted this diet, I am surprised that I did not do it 
years ago. In one way the effects of the diet have surprised me. I have been a 
heavy smoker for more than twenty years. If there was anything which I feared 
my will was too weak to conquer it was the habit of smoking. Well, I have been a 
vegetarian for eight weeks, and I find my passion for tobacco is weakening. 

Again, I have found I can not drink wine. Why do I write these confessions? 
Because these things have come upon me as a revelation; because I begin to see that 
the great cure for the evil of national intemperance is not a teetotal propaganda, but 
vegetarianism. 

It will be observed that that which his will was too weak to con- 
quer while subsisting on a mixed diet he had no difficulty in giving 
up after he had eliminated flesh from his dietary. This demonstrates 
that for the mental defective a meatless diet is essential. "One be- 
lieveth he may eat all things; another who is weak eateth herbs." 
But to the mentally strong the words are addressed: "It is good 
neither to eat flesh nor to drink wine, nor anything whereby thy 
brother stumbleth or is offended, or is made weak," for that which 
is so injurious to the weak will in time weaken the strong. For years 
we have successfully employed a meatless died in connection with 
other measures in treating alcoholics in our sixty or more sanitariums. 
We have had it demonstrated repeatedly that upon a nonirritating, 
nonstimulating diet the craving for drink weakens, and if continued 
sufficiently long it disappears, but reappears as soon as meat and 
irritating foods are again eaten. 

The Salvation Army in some of its homes for inebriates has also 
adopted this diet with good results. At a public gathering in Eng- 
land, Staff Captain Hudson, matron of the South Newington Inebri- 
ates' Home, in relating her experience in the treatment of cases, said : 

Speaking generally, the benefits of this diet are incalculable. Lazy, vicious, 
bloated, gluttonous, bad-tempered women, who had hitherto needed weeks and even 
months of nursing and watching, to my astonishment and delight, under this new 
treatment, made rapid recovery. 

The majority of the Japanese live chiefly on rice and fruits, and 
they undoubtedly possess the best dispositions to be found among 
any people in the world. On the streets of Japan fighting and quar- 
reling are seldom seen, and drunkenness is said to be unknown. 
Courtesy and ceremonious manners are as prevalent in rice-eating 
Japan as grumbling and beer-drinking are in beef-eating England. 

Overeating is another cause of drunkenness. The confession 
anciently forced from the lips of parents, "This our son is stubborn 



THE ALCOHOLIC PKOBLEM. 57 

and rebellious, he is a glutton and a drunkard/' explains the intimate 
relation that exists between overeating and drunkenness. 

It is generally recognized that two-thirds of the food consumed by 
the average civilized man would sustain him well; the remaining 
one-third is therefore superfluous and forms food for bacteria. The 
poisons produced by fermentation and putrefaction serve to irritate 
and disarrange the organs of digestion and, when absorbed, the 
nervous system. Nothing will afford relief so quickly or so effectively 
as will alcohol. Naturally overeating leads to drunkenness. 

A great variety of even wholesome food when taken at the same 
meal cause similar symptoms. Both nature and science teach that 
the digestive organs are capable of digesting well one or two simple 
foods, but when, as is often the case, potatoes, cabbage, milk, butter, 
puddings, fruit, pastry, etc., are taken at the same meal, indigestion, 
fermentation, and autointoxication are sure to result. By the putre- 
faction of protein in the colon toxins are formed which tend to in- 
crease the blood pressure and produce neurasthenia. This explains 
why neurasthenics seek for something to decrease this nervous 
tension; this something they discover in alcohol. In my practice I 
have found hyperchloridia and neurasthenia usually associated, and 
yet it is customary to place such cases on a meat diet. This is no 
doubt one reason why it has been so difficult in the past to help the 
neurasthenic. The protein combines with the acid and for a time 
affords relief from local irritation, but the urates and other extrac- 
tions serve to stimulate the production of gastric juice. That which 
temporarily palliates permanently intensifies the hyperchloridia and 
neurasthenia and also the desire for drink. 

Hypochloridia also leads to alcoholism, for the one who has con- 
stantly dealt out o his body the narcotics and irritants formed in 
his alimentary canal in small quantities from putrefaction and 
fermentation of foods is as truly cultivating a craving for alcohol as 
though he habitually partook of small doses at stated intervals. 
The only difference is one is fortunately unconscious of what his 
system craves, the other unfortunately is not. The hypochloridic 
eats freely of sugar, potatoes, etc., and forms the alcohol within his 
body ; a change of diet upsets him as badly as the one who has been 
accustomed to taking small doses of alcohol when deprived of it. 

History furnishes evidences that among the races of people freest 
from alcoholic excesses such luxuries as tea, coffee, meat, and 
cane sugar were rarely if ever used, and complicated mixtures were 
unknown; that they derived their nutriment chiefly from the non- 
stimulating and nonirritating products of the earth served in the 
most natural way. 

The reason why the desire for drink is confined to the human family 
is that among all creatures, aside from man, a simple diet is the rule. 
The horse is content with his simple meal of unseasoned oats; no 
mustard or pepper or even sugar need be added to give him a relish 
for his hay. The horse as a consequence craves no drink aside from 
water. If civilized men exercised the same good sense in their eating, 
there would probably be as little desire for alcohol among them as 
there exists among horses. 

The inebriate must be taught what to eat and how to eat. This can 
be best done in homes established for the treatment of such cases. 



58 THE ALCOHOLIC PROBLEM.- 

Starch is an essential food element and is widely distributed in 
nature. But the free use of soft starchy foods, and improper mastica- 
tion, are causes of drunkenness, since they favor fermentation and 
auto-intoxication. Starchy foods must have incorporated with them 
saliva. This necessitates prolonged retention in the mouth or 
thorough mastication. 

The free use of liquids with meals is also responsible for digestive 
disorders and fermentation. Of all creatures, man alone drinks with 
his meals. Drinking with meals is wholly unnatural. Nature de- 
signs that the food should be moistened with saliva, not with drink. 
Drink dilutes the small amount of saliva that may by chance have 
come in contact with the food while gliding through the mouth, and 
also dilutes the gastric juice, and therefore delays digestion of both 
the starches and proteins and favors fermentation and putrefaction. 

Condiments also create a desire for narcotics. Because food is 
bolted and not allowed sufficient time in contact with the nerves of 
taste located in the mouth to derive satisfaction from its delicate and 
natural flavor, pronounced artificial flavors have to be added which 
will give an immediate twist to the palate. This has led to the use 
of pepper, mustard, and the free use of salt and sugar, and other sub- 
stances which irritate the stomach. These help to create and keep 
up the thirst for narcotics. 

Professor Metchnikoff says "the human system is poisoned in no 
way so frequently as by the innumerable microbes which swarm in 
the large intestine." Recognizing the evils resulting from the forma- 
tion of these poisons in the colon, by the action of this innumerable 
host of microbes, he finds fault with man's construction. He says 
"this organ is not only useless in man's present state, but positively 
harmful," and predicts that in the future it may be successfully re- 
moved with advantage to the individual. "Man," he says, "is very 
far from being perfectly constructed." The difficulty, however, lies 
in man's inventions and not in his construction. So long as man con- 
tinues to make errors in the selection of his food he will cultivate bac- 
teria and the poisons which create a thirst for narcotics. 

Huf eland, the eminent German physiologist of a century ago, dis- 
covered this relation between certain foods and autointoxication. 
He said: 

Animal food is more liable to undergo putrefactive changes in the alimentary tract, 
while substances of the vegetable kingdom contain acid principles that retard our 
mortal enemy, putrefaction. 

Cheese is not a suitable food. While it contains desirable elements, 
these have associated with them irritants and other undesirable sub- 
stances. It is not only difficult to digest, but it contains bacteria in 
large numbers, and aside from this it is a product of putrefaction. 
Like meat, it creates irritation or thirst, which it is difficult to quench 
with water. 

The free use of butter retards digestion and favors the cultivation 
of bacteria and the formation of buteric acid. Buteric acid acts as a 
local and general irritant. The oil in nuts or olives is preferable to 
butter or any other animal fat, since they are free from bacteria and 
do not ferment readily. 

The aim in diet, especially for inebriates, should be to make the 
intestinal culture media as unfavorable as possible for the existence 
and propagation of dangerous bacteria, or to secure as far as possible 



THE ALCOHOLIC PROBLEM. 59 

an aseptic or sterile condition of the alimentary tract. The foods 
which are best suited to bring this about are the simple grains, nuts, 
and fruits, taken in their most natural state. Grains may be pre- 
pared in various ways to make them easier of digestion, but the fruits 
and nuts require no preparation aside from mouth preparation. 

The food question when given the attention it demands by physi- 
cians, ministers of the gospel, and temperance advocates will not only 
remove the existing desire for strong drink, but will result in the 
removal of much of the crime and domestic unhappiness that at 
present exists because of drink. 

Doctor Wiley, in addressing the American Bakers' Association at 
Atlantic City recently, said : 

Good bread, in my opinion, would help to solve the American evil of divorce. If 
bakers make good bread and then educate the people to buy it, the great destroyer 
of domestic unhappiness, dyspepsia, will be removed, and we will hear no more of 
the divorce problem. 

Sydney Smith, many years ago, in a letter to Arthur Kingslake, 
said: 

I am convinced digestion is the great secret of life. Character, talents, and virtues 
are powerfully affected by beef, mutton, pie crust, and rich soup. I have often 
thought I could feed or starve men into many virtues and vices and affect them more 
powerfully with my instruments of cookery than Timotheus could formerly with his 
lyre. Frequently those persons whom God has joined together in matrimony, ill- 
cooked joints and badly boiled potatoes have put asunder. 

While I recognize there are other side paths leading to inebriety and 
do not wish to convey the idea that errors in diet are wholly respon- 
sible for the drunkenness that exists, I am convinced that dietetic 
errors are among the chief causes of inebriety, and this being so, 
the diet question must be given the attention it deserves if we would 
help the inebriate. 



PAPERS RELATING TO THE QUESTIONS OF RESPONSIBILITY 
AND THE PUBLIC CARE OF INEBRIATES. 



61 



MENTAL RESPONSIBILITY IN ACUTE AND CHRONIC ALCO- 
HOLIC INTOXICATION. 



By Alfred Gordon, M. D., Philadelphia, 
Professor of mental and nervous diseases in the Jefferson Medical College. 



A problem of the greatest importance confronts us when we are 
requested to determine the degree of responsibility of an individual 
who committed an illegal or criminal act in state of intoxication 
with alcohol or other drugs. 

In an effort to arrive at the proper conclusion one must naturally 
consider two possibilities, viz, whether the intoxication occurs in an 
individual with a preexisting mental affection or without the latter. 
As it is well known a tendency to all sorts of excesses is not an infre- 
quent accompaniment of various psychoses. A similar tendency is 
observed also in epileptics, in individuals with physical and mental 
stigmata of degeneracy. Finally, excesses are committed sometimes 
by persons totally free from hereditary or acquired abnormal stigmata. 

It should be equally taken into consideration the fact that illegal 
or criminal acts are committed not infrequently by individuals 
whose intoxication is quantitatively not excessive, but on whom small 
and even minute doses of intoxicating elements produce such an effect 
as to develop dangerous impulses. This is seen, for example, in some 
neuropaths, imbeciles, feeble-minded, etc. 

With these preliminary remarks, let us first consider the question 
of responsibility in intoxication with alcohol. 

Alcoholism may be acute and chronic. To the latter belongs also 
a special form characterized by an episodic irresistible desire to 
absorb alcohol. It is known under the name of "dipsomania." 

The mental phenomena of acute alcoholism are, briefly, as follows: 
The individual experiences at first a sense of " well-being" and of 
abnormal vigor. His ideas appear to him to be clear, he finds no 
obstacles, everything appears to him easy, his physical and intel- 
lectual force appear to him invincible. The faculty of speech is 
extraordinarily good, and the most morose becomes loquacious. 
Soon, however, the reasoning power becomes obnubilated. The 
phase of depression sets in. Consciousness is clouded, the will power 
disappears, the instincts predominate. At this stage abnormal and 
irregular acts or crimes may be committed. 

When the intoxication is more profound, delirium and hallucina- 
tions with their familiar picture develop. When an acute intoxica- 
tion occurs in an epileptic, in a neuropathic individual, the above 
phenomena are still more pronounced. Epileptic seizures are fre- 
quently brought on by acute intoxication. A delirious state of 
unusual severity or acts of violence may follow an absorption of 

63 



64 THE ALCOHOLIC PROBLEM. 

small amounts of alcohol in neuropathic individuals. In individuals 
previously insane a drink of alcohol may be the exciting cause for 
intensification of delusions, for sudden violent acts of the most 
brutal nature. 

Chronic alcoholism, according to some, must follow frequently 
repeated acute attacks of intoxication. While this may occur, it 
is not always the case. Most frequently we meet with individuals 
who are never drunk in tbe proper sense of the word, but regularly 
absorb small amounts of alcohol at various intervals, two to three 
times daily, for months and years. These are the cases in which a 
chronic poisoning of tissues, organs, humors is established by grada- 
tion. Clinically alterations of various functions, anatomically pro- 
liferation of connective tissues followed by degeneration of superior 
elements are observed. 

It is superfluous to enter into a detailed description of the material 
changes which various organs undergo. They are too well known 
to dwell upon. Suffice it to mention that the most serious conse- 
quences are observed in the cranial cavity. Thickening of the 
meninges, irritation and degeneration of the noble elements of the 
brain are very common. The cerebral arteries undergoing profound 
changes, easily rupture under the influence of a slightest traumatism 
or even spontaneously. Hemorrhages and suspension of cerebral 
function are the result. Besides hemorrhages, the cerebral circu- 
lation is always retarded because of the diminution of the arte- 
rial caliber, the cerebral tissue is disturbed in its nutrition, and the 
functions naturally suffer. 

A chronic alcoholic individual is always predisposed to attacks of 
meningitis, to deliria. An intervening illness of any nature, a slight 
traumatism, are apt to provoke in him various sensory disturbances, 
hallucinations in the sphere of the special senses. The picture of 
delirium tremens is well familiar to us all. 

The profound anatomical changes developing gradually in cases of 
chronic alcoholic intoxication lead to a gradual deterioration of cere- 
bral functions. The latter grow parallel with the degree of intoxica- 
tion, but depend also upon the idiosyncrasy, heredity, and the make- 
up of the individual. 

Amnesia for certain special subjects or else of a more generalized 
character, irritability, susceptibility, outbreaks of anger, are the 
initial symptoms. Later on the patient becomes indifferent, loses all 
affection for the near and dear ones, becomes hallucinatory, illusional, 
delusional. The oncoming dementia is the fundamental feature of 
any of the periods of chronic alcoholism, and during any of its phases 
the most peculiar acts and crimes may be committed. Such is the 
mental status of individuals who consume regularly and daily fre- 
quently repeated doses of alcohol and at the same time consider 
themselves free from intoxication. This fact is frequently over- 
looked and misinterpreted. 

A variety of chronic alcoholism, called "dipsomania," presents a 
very important chapter from the medico-legal standpoint. It is 
characterized by paroxysmal imperative desire for alcohol, coming 
on sometimes at regular intervals. This desire is so morbidly intense 
that the patient is unable to resist and at all price he must satisfy 
his irresistible craving. Crimes have been committed during this 
state. I know of a married woman, deprived of money by her 



THE ALCOHOLIC PKOBLEM. 65 

husband because of her tendencies, became a prostitute to procure 
the necessary means for the purchase of whisky. Such individuals 
should therefore be considered insane. 

Having briefly considered the three main possibilities of alcoholic 
intoxication and the mental condition of individuals affected with 
each of these varieties, let us take up the crucial question of respon- 
sibility. Otherwise speaking, we are to consider under what cir- 
cumstances the author of an illegal act or of a crime is or is not respon- 
sible for the committed act. 

First of all we must exclude from our consideration cases with 
preexisting mental affections in which a tendency to alcoholic or 
other excesses is great. A paretic, a paranoiac, a maniac, may become 
acutely intoxicated and commit violence, assault, homicide, etc. 
They can not be held responsible, as their ixtoxication itself is the 
result of a morbid irresistible impulse created by a deranged mind. 

When an individual free from mental diseases abandons himself 
to drink and during the state of acute intoxication commits an illegal 
act, should he be held responsible ? 

Here two possibilities may occur. Either the individual, premed- 
itating a crime, voluntarily and intentionally becomes intoxicated 
with the object of finding an excuse, or else the crime was committed 
by an individual without premeditated intoxication. In the first case 
the individual was well aware of the consequence of intoxication, and 
he certainly knew from his previous personal experience and from 
observation of others that acts of violence are frequently committed 
when in a state of intoxication. Such an individual is totally and 
fully responsible for his acts. 

On the other hand, an intentional intoxication may occur in neuro- 
pathic individuals, in feeble-minded, in imbeciles, in epileptics, and in 
individuals suffering from obsessions and various morbid impulses. 
A question naturally arises : Should we consider totally responsible a 
person who all his lifetime presented evidences of an abnormal men- 
tality, although not, properly speaking, insane, evidences of arrested 
development or other deviations from the normal — if such person, I 
say, by reason of some insignificant grudge, anger against a friend, a 
neighbor, a relative, will conceive the idea of revenge, become intoxi- 
cated, and commit a crime — should we consider him or her entirely 
responsible ? 

It is true that whether the delinquent is a degenerate or not, society 
has the right to protect itself against criminals, but has it the right to 
protect itself with the same means against everyone without endeavor- 
ing to find out if among them there are diseased individuals ? Has it 
the right to get rid of all offenders by sending them pell-mell to the 
electric chair or to prison for life, by inflicting punishment only be- 
cause of their nocivity and a certain degree of danger, without taking 
into consideration the state of their mental health? 

Some will say, "When a dog is enraged, kill it; when a man 
commits a crime, hang him; there is no use for society to waste its 
energy and means in taking care of criminals." We physicians have 
always been from time immemorial protectors of afflicted humanity. 
It is our duty to protest against such a utilitarian spirit and to pro- 
tect diseased individuals against indiscriminate and wholesale 
sacrifice. 

S. Doc. 48, 61-1 5 



66 THE ALCOHOLIC PROBLEM. 

When an epileptic individual commits a crime during a seizure, he 
is totally irresponsible. But when the same inveterate epileptic, whose 
cerebral convolutions are continuously in a state of irritation, commits 
an illegal act in the intervals between the attacks, when he certainly 
knew very well what he was doing, can he be considered totally 
responsible ? 

Individuals suffering from obsessions, phobias, from folie de doute, 
delire du toucher, from abulia or deficient inhibition, individuals pre- 
senting all forms of deviation from normal cerebral functions, the 
so-called peculiar, eccentric, queer, without being insane in the 
proper sense of the word, individuals who present an arrested mental 
development of all degrees and forms from simple backwardness to 
the low grade of imbecility — all these are persons whose psychic 
make-up can not be considered normal and at the same time not 
morbidly deranged; they can not, therefore, be considered irrespon- 
sible and at the same time are not totally responsible. They form the 
intermediary class, to which Gr asset has luckily applied the term 
"demifous.' 7 Their responsibility also occupies an intermediary 
place and is only limited. This is a clinical observation which can not 
be denied and the objection of some that one can be only either 
totally responsible or totally irresponsible can not hold ground before 
an everyday clinical fact. 

Regis has recently said: 

Mankind unfortunately can not be divided from a psychological standpoint into 
two distinct categories, viz, on one side mentally sane or totally responsible and on the 
other side insane and totally irresponsible. Between the two there is a large province, 
so-called intermediary zone, populated by individuals tainted in various degrees and 
consequently presenting very different degrees of responsibility. Although it is 
impossible to measure the latter by millimeters, it is nevertheless possible to establish 
for them from this standpoint an ascending or descending scale and consider quite 
precisely three progressive degrees, viz, slightly, sufficiently, and very largely limited 
responsibility. The application of the principle of limited responsibility in practice 
is very important for the expert, because a very large number of cases that are sub- 
mitted to him for an examination present the incomplete and intermediary patho- 
logical states spoken of above, which can not and do not correspond to absolute 
mental responsibility, but only to a limited responsibility. 

Limited responsibility therefore is not a subterfuge of an expert, 
but a scientific fact established upon scientifically accurate observa- 
tions. 

Now, if independently of acute alcoholic intoxication an individual 
presents the qualifications for an incomplete responsibility, it stands 
to reason that he should be considered as such when he commits an 
illegal act in a state of acute intoxication. 

Let us now turn our attention to the question of responsibility in 
chronic alcoholism. 

As we have seen above, there are various degrees of intoxication, 
but in all of them the predominant feature is the progressively 
developing mental enf eeblement ; the sum of knowledge is gradually 
being reduced, the disturbance of memory is visibly manifest, and the 
total circle of ideas is getting more and more narrow; the reduced 
mental operations are, however, sometimes masked by certain 
emotional reactions which apparently supplement the psychic deficit 
in a fictitious manner. What characterizes particularly this mental 
state is the gradual and progressive disappearance of the faculty of 
discrimination, and this precisely constitutes a very important factor 
from the standpoint of responsibility. 



THE ALCOHOLIC PKOBLEM. 67 

Criminal acts are therefore to be expected. If not all individuals 
have a criminal record, the majority are in a state of imminent crimi- 
nality. Once a crime committed, the act is frequently repeated. 
Recidivism is therefore an important element in the study of the 
problem. Chronic alcoholic individuals fill our prisons and reform- 
atories, as they are considered before courts of justice as vicious and 
incorrigible delinquents, but in reality they are not less diseased than 
many other lunatics. It is only exceptionally that some of them are 
recognized to be insane, but the majority are considered only crimi- 
nals when they are caught in an illegal act. That criminality is 
enormous in chronic alcoholics, it is sufficient to mention Baer's sta- 
tistics in Germany, where out of 32,857 convicts 30,041 are chronic 
alcoholics. According to Forel (International Penal Congress, 1905, 
vol. 1) chronic alcoholism is the cause of the majority of crimes and 
it is a disease of the brain. Heilbronner (Die akuten Geistes- 
krankheiten der Gewohnheitstrinkern, 1901) says that some chronic 
alcoholic individuals who are apparently without manifest psychic 
disturbances are from the ethical and moral standpoints not superior 
to early paretics. Cramer in his treatise on legal psychiatry says 
that the state of degeneration to which chronic alcoholism leads 
should be considered as a diseased condition and therefore excludes 
free volition. When we take into consideration the fact that chronic 
alcoholism is accompanied by an intellectual deficit, lack of volition, 
affective ansethesia, moral perversity, suggestibility, automatism, im- 
pulsiveness, all symptoms which we meet in various psychoses, we 
are forced to admit that a pathological mentality is the fundamental 
feature of chronic alcoholism. These arguments, I believe, are suf- 
ficient to solve the problem of responsibility. The conclusion forces 
itself upon us that a chronic alcoholic individual is a diseased indi- 
vidual, and therefore can not be held responsible for his acts. Recid- 
ivism, which is so characteristic of such cases, proves that it is a 
veritable constitutional disease. A question naturally arises whether 
the chronic alcoholics at all stages should be considered irresponsible 
and whether degrees of responsibility are not to be considered. 
Mental degeneration in such cases is of course a progressive process 
and dementia develops gradually. Consequently a person with a 
mild degree of mental enreeblement can not be looked upon as iden- 
tical with a person whose mentality is much more deteriorated. 
While this contention is correct, nevertheless the principle remains 
intact, viz, that in both cases or rather in all cases of chronic alcoholic 
intoxication the individual is a patient requiring medical supervision, 
a patient that is liable to commit illegal or immoral acts, and that 
chronic alcoholism is a veritable disease. 

When we consider dipsomania from the standpoint of responsibility, 
we encounter some difficulty. The dipsomaniac in the early stages 
of his infirmity presents apparent lucidity of mind and control of his 
faculties during the intervals between the attacks of irresistible crav- 
ing for drink. As dipsomania is always the result of a chronic use of 
alcohol, a gradual deterioration of cerebral functions becomes evi- 
dent in its later stages, as we have seen above in describing the picture 
of chronic alcoholism. 

Whether in the early or later stages of this affection, dipsomania 
per se is a disease; an impulsive act of any nature which the indi- 
vidual thus affected is absolutely unable to resist and of which he 



68 THE ALCOHOLIC PROBLEM. 

can not give a proper account is certainly a pathological phenomenon. 
Dipsomaniacs, therefore, are diseased individuals in whom mental 
responsibility can under no circumstances be considered complete. 
The degree of the latter depends upon the stage of the disease. It 
will be limited in the early phase of the affection or when the latter 
occurs in neuropathic individuals. In this case the individual's power 
of reasoning is sufficient for a realization of the criminality of the act, 
but being affected by a malady which interferes with his normal life, 
although paroxysmally nevertheless sufficiently strong to obnubilate 
his mental horizon, such an individual can not be considered totally 
responsible. This remark is particularly applicable to neuropathic 
individuals who, as we have seen above, are not insane in the proper 
sense of the term, but present a special make-up of the nervous sys- 
tem which deviates from normal. Dipsomaniacs in an advanced 
period, when enfeeblement of mental faculties, viz, dementia, is evi- 
dent, no matter how mild the latter may be, are and should be con- 
sidered totally irresponsible for their acts. In this case a crime com- 
mitted in the intervals between the paroxysms is done by an individual 
whose power of reasoning and discrimination is lessened or perverted, 
whose inhibitory power is therefore lessened, and such an individual 
is unable to appreciate the enormity of a crime ; he is therefore insane. 

INTOXICATION WITH OPIUM AND COCAINE. 

In my study of 171 cases of morphinomania and cocainomania, 
published in the Journal of American Medical Association, 1908, a 
detailed account of the mental status of such individuals is given. I 
considered there the psychic phenomena of acute and chronic intoxi- 
cations with each of these drugs, of mixed intoxication, also the mani- 
festations accompanying abstention. On a whole the acute and 
chronic states resemble those of acute and chronic alcoholism. Here 
and there we find, generally speaking, the delirious, confusional, and 
stuporous conditions, with or without hallucinations, characteristic of 
the acute period of intoxication. Here and there we observe the 
gradual mental deterioration, viz, dementia, characteristic of chronic 
intoxication. 

The special phenomena referable to cocaine consists, as seen from 
my study, of peculiar tactile hallucinations which are usually not 
encountered in alcoholism. Another peculiarity worth mentioning is 
the observation that out of 52 (among 60) acute morphia patients 
who have totally recovered, 32 presented for weeks mental disturb- 
ances; they showed slowness of thought and difficulty of grasping 
complicated subjects; questions had to be repeated a number of times 
before they could comprehend them; there was a striking mental 
fatigue. Among the patients acutely intoxicated with cocaine some 
for six subsequent weeks suffered from insomnia, vertigo, and attacks 
of delirium, and one of them was unable to resume his occupation of 
office clerk for six months because of deficient memory and inability 
to solve the simplest mathematical problems. In the chronic form 
of intoxication the moral sense suffers profoundly. The patient 
loses the sense of obligation to his family; he loses affection for his 
children, becomes egotistic. The will power is deficient. Excesses 
of all sorts are common; deception and crime are frequent. 



THE ALCOHOLIC PEOBLEM. 69 

Dementia is the usual outcome of chronic intoxication. In my 
series of 70 morphia cases it was particularly marked when delusions 
and hallucinations were absent. In the cocaine cases the special 
hallucinations mentioned above were more pronounced in the chronic 
than in the acute form ; they lead to formation of delusive ideas which 
are mostly of persecutory nature. A progressive decrease of intel- 
lectual force is also observed in chronic cocainomania. 

The phenomena of abstention I studied in 31 cases. The picture 
of extreme suffering was complete; the patients were restless, full 
of anxiety, agitated, and incapable of listening to others, of following 
a conversation, of reasoning, or of reflecting. Delirium and halluci- 
nations were sometimes present; when they occurred their manifes- 
tations were more violent than in delirium tremens. When abstention 
was practiced in advanced cases with signs of dementia, no improve- 
ment in the mental condition was noticed. A gradual withdrawal of 
the drug or drugs produced besides anxiety also a state of depression. 

When we compare these mental disturbances with those of alco- 
holism we find great analogy, if not identity. 

The problem of mental responsibility in morphine and cocaine 
intoxications is practically that of alcoholic intoxication. 

When a criminal act is committed by an individual who, being 
under the influence of acute intoxication with morphine and cocaine 
is in a delirious state and has hallucinations, who is then incapable 
of distinguishing between right and wrong, whose cerebral functions 
are in a state of dissociation, can he be considered responsible for his 
acts from a medical standpoint? 

Cases with preexisting mental affections in which a tendency to 
excesses and to the use of drugs is great must naturally be excluded 
from our consideration. In such cases the intoxication itself is the 
result of a morbid impulse caused by the insanity. These patients 
can not be held responsible when they commit a crime while under 
the influence of the intoxication. 

Outside of this possibility the discussion elaborated apropos of the 
question of responsibility in acute and chronic alcoholic intoxication 
is entirely applicable here. 

When an intentional intoxication occurred for the purpose of 
committing a crime, the responsibility is complete. 

When intoxication occurs in neuropathic individuals,, for the rea- 
sons elaborated above the responsibility is only limited. The 
latter should also be accepted when the patient has recovered from 
the immediate effects of acute intoxication, but remains for weeks, 
as I have shown in some of my cases, mentally dull, apathetic, 
with lack of sustained attention and difficulty of comprehension. 

In the chronic form of morphinism and cocainism similar to chronic 
alcoholism mental degeneration and subsequent dementia are of a 
gradual but progressive nature. A person with a mild degree of 
mental enfeeblement can not be considered as identical with a per- 
son whose mentality is much more deteriorated. Consequently the 
impairment or disappearance of the moral sense, deficiency of the 
will power, and even a mild diminution of intellectual faculties 
do not entirely exempt a morphine habitue from responsibility; 
the latter is only limited. When, on the other hand, delusive ideas 
or hallucinations are present, the irresponsibility is total. 



70 THE ALCOHOLIC PROBLEM. 

When the patient reaches the stage of dementia, even in the 
absence of delusions, he can not be held responsible for any of his acts. 

In conclusion, I wish to emphasize the object of the present study. 
It is a very well-known fact that in a great many instances the 
medical and legal conceptions of insanity and responsibility are not 
in accord. The legal requirement of the test of right and wrong 
as the only means of determining the criminal's responsibility or 
irresponsibility is inadequate and does not conform with our 
present scientific knowledge. To harmonize the legal and medical 
views and to find a compromise between the two apparently antag- 
onistic fields is, I confess, a difficult problem. This subject is of a 
vast practical importance and will form the basis of a special study 
at some future time. In the present essay I have considered exclu- 
sively the medical aspect of mental responsibility. I have endeavored 
to show by means of accurate scientific observations, experimental, 
pathological, and clinical, that when in presence of an antisocial act 
one must ask oneself if the individual having committed it was 
capable totally or only to a limited degree to understand the impor- 
tance of the act; if he could appreciate all the consequences; if he 
has not undergone some predominating morbid influence; shortly 
speaking, if he was scientifically responsible or irresponsible irre- 
spective of legal difficulties or intricacies. 

Criminality is a phenomenon of social pathology and must there- 
fore be studied from the standpoint of biological sciences. 






THE MEDICO-LEGAL CARE OF ALCOHOLIC DEFECTIVES. 



By G. Alfred Lawrence, LL. B., Ph. D., M. D., New York, 

Instructor nervous and mental diseases, New Yorh Postgraduate Medical School, visiting 

neurologist City Hospital, etc. 



The proper care of the thousands of men, women, and children 
who annually succumb to the overpowering influence of the alcoholic 
habit, which holds so many of them in its relentless grasp until death 
terminates the scene, is becoming a serious problem, not only from 
the medical and legal standpoint but also from the social, civil, and 
economic aspects of the case. The enormous sum of $1,325,439,074 
was spent during the year 1905 in the United States for liquor, and 
a vast army of incompetents, numbering 1,500,000 men and women, 
were daily incapacitated for work during that same period, making 
a total cost of over $3,000,000,000 for and from the direct effects 
of alcohol to this nation alone. England spends nearly a billion 
dollars annually in drink, and if we added up the total expenditures 
of all the nations of the earth for alcoholic liquors, with the addi- 
tional cost to these nations from the effects of the stimulant, the 
wealth of even a modern Croesus would seem but a mere bagatelle 
in comparison. Yet with such statistics on record the legislature of 
the great Commonwealth of New York, the Empire State of the 
Union, last year failed to pass a bill for the appropriation of a paltry 
$15,000 for the purpose of creating a commission to study the treat- 
ment of inebriates and persons addicted to the excessive use of nar- 
cotics and their relation to the commission of crime and, furthermore, 
of establishing a state institution for the care of such persons, the 
members of the commission to serve without salary and the above 
sum to be expended only for the expenses of the said commission. 
This bill failed of passage on the ground that the State did not have 
the necessary money to devote to such a purpose! 

Alcoholics requiring medico-legal care from an etiological stand- 
point may be divided into three general classes : 

(1) Cases having a defective heredity, as alcoholism, syphilis, 
tuberculosis, some nervous or mental disease, etc., in one or more 
ancestors. These are not only the least promising but the least 
amenable to care and treatment. 

(2) Cases initially healthy and with good heredity, but acquiring 

some severe, organic, or functional disease, as syphilis, tuberculosis, 

cancer, a neurosis or psychosis, and afterwards becoming addicted 

to the alcoholic habit. This class is of greater promise, but many 

fail of permanent cure. 

71 



72 THE ALCOHOLIC PROBLEM. 

(3) Cases of good heredity and free from any acquired disease, but 
who drink to excess. These cases are most amenable to treatment, 
and a larger percentage can be permanently cured if treated for a 
sufficient length of time and in a suitable environment. In all three 
of these classes we may have acute, subacute, or chronic forms of 
alcoholic psychosis or defective mental states, requiring medico- 
legal care. Statistics show that some 55 per cent of all cases of alco- 
holics if properly treated may be cured. If the habit results in an 
actual insanity, care in either a public or private hospital for the 
insane may be necessary during the period of complete mental 
alienation. This period, however, may continue only for a very 
brief time, and if the patient makes the demand he must be liberated 
as soon as mental alienation ceases, and only too often goes forth 
before he is really capable of properly caring for himself, with dimin- 
ished resistive force, to again fall victim to his alcoholic habit. When 
such cases reach a condition that permits them to leave the insane 
asylum, they — with those cases in which mental alienation is not 
complete, but there is an inability to control the morbid desire for 
drink, so that they may become an economic burden to their family 
or to the State, a violator of the law, etc. — should be legally com- 
mitted for care and treatment to some colony for inebriety and there 
remain until such time as the superintendent and his staff (who 
should all be expert inebriatists) consider that the patient is cured 
and capable of again going forth into the world and assuming 
all the necessary obligations of a useful member of the body politic. 
Such a colony should be situated near a great center of population, 
and easily accessible. In some of the larger States, as New York, 
Pennsylvania, and Massachusetts, several such colonies could be 
maintained at a great economic saving to the Commonwealth. A 
colony of this character could be partially self-supporting by the 
sale of farm and garden produce and the products of various indus- 
tries, that could be maintained by the labor of the alcoholics super- 
vised by a very small staff of paid employees. Such a colony should 
have a large tract of arable land with some woodland, so that various 
crops, vegetables, dairy products, and timber or wood might be 
obtained. Workshops or special factories should be erected where 
upholstering, wood carving, leather and metal work, basket and rug 
weaving, pottery and clay modeling, harness making, blacksmithing, 
carpentering, stenciling, printing, bookbinding, and various other 
forms of handicraft might be carried on by the alcoholics acting as 
farm hands, dairymen, artisans, messengers, orderlies, clerks, attend- 
ants, and helpers of various sorts. Centrally located should be an 
administration building, a hospital, an amusement hall, with stage 
for theatricals, billiard and pool tables, reading room, and gymnasium, 
the latter containing a swimming pool, bowling alleys, hand and 
tennis courts, etc. 

Suitably arranged about these central buildings, and upon a 
detached-cottage place, groups of small dwellings should be erected, 
each to accommodate from 10 to 30 patients; practically the entire 
care of these cottages could be left to the patients who occupied 
them. The sexes should be separated and occupy different parts 
of the colony with the exception of coming together for dances, 
entertainments, and religious services. This detached-cottage plan 



THE ALCOHOLIC PROBLEM. 73 

would permit of a suitable classification of the various forms of 
inebriety. A church for religious services and laboratories for scien- 
tific research should also be erected. 

A medical superintendent with an adequate staff of physicians, all 
skilled inebriatists ; should carefully examine every case admitted to 
the colony, secure a complete history of the same, and keep an accu- 
rate record of his condition during the entire period of his residence, 
classifying him, directing his treatment, and selecting a suitable 
occupation as best adapted to the particular skill or training of the 
individual. All cases sent to such a colony should be under legal 
commitment, so that the medical staff can have the proper authority 
to direct the treatment of the patient along the lines best adapted 
to the individual need of the case and for a suitable length of time. 
This system of colony care of inebriates would be a much less eco- 
nomic burden to the State than the vast economic waste that now 
goes on from the lack of proper restraint of this rapidly increasing 
class of unfortunate defectives. As an illustration, of the 2,593 
inmates of the New York City almshouse, 90 per cent are there 
through drink and are a complete economic burden to the city, 
whereas if placed in such a colony many could do some work, and 
thus partially pay for their care. That such a colony could be self- 
supporting is borne out by the reports of the Craig colony for epilep- 
tics at Sonyea, N. Y. In this very successful colony, consisting of 
over 2,000 acres of farm and woodland, there are some 1,200 epileptics 
many so defective as to be unable to do anything, and yet in 1906 
the produce from their farm, garden, and numerous industries reached 
the total value of $42,000, and practically most of the work was done 
by the patients. The maintenance of such colonies near great cen- 
ters of population and conducted along the general lines above 
indicated would be a distinct step in advance in the care of this 
continually increasing class of defectives, and would be of material 
economic saving to the nation in conserving wealth, diminishing 
crime, and improving the general health. 



THE RELATION OF THE PAUPER INEBRIATE TO THE 
STATE FROM AN ECONOMIC POINT OF VIEW. 



By Lewis D. Mason, M. D., Brooklyn, N. Y., 
Vice-President of American Association for the Study of Alcohol and other Narcotics. 



Public sentiment is comparatively easily interested in the epileptic, 
the consumptive, the pauper, the orphan, the sick and aged, the 
insane, the idiot, and the feeble-minded, and those deprived of the 
use of organs of sense. 

Hence colonies, hospitals, sanitariums, almshouses, educational and 
industrial institutions are organized and sustained largely through 
a sympathetic influence acting on public and private benevolence; 
nor do we exclude the claims of public necessity, nor fail to apply 
the principles of economic administration in the care of such cases. 

We recognize the imperative fact that the criminal must also be 
cared for, on the ground of public necessity and absolute protection 
for the community. 

Society must be safeguarded against the vicious, the malicious, 
and criminal classes. 

Whatever the character of the institution or colony may be, 
whether eleemosynary or penal, economy must enter into the con- 
sideration of the case of the unfortunate or vicious classes of society; 
and the problem eventually resolves itself of necessity into one of 
finance. 

The question is, How shall we do the best we can for these wards 
of the State at the least possible cost to the law-abiding and indus- 
trious portion of the community, the taxpayers of our Commonwealth? 

With the inebriate it is different. The public look upon him as 
the voluntary subject of a vice, and will not realize the fact that 
we are dealing with an irresponsible class who, at least in a large 
measure, have passed beyond the limit of responsibility, and a class 
from which the degenerate and criminal classes are so largely recruited, 
and from which originate, in a great measure, the criminal, the 
pauper, the sick, and the insane that fill our penal and charitable 
institutions. 

Public sentiment has dealt with the inebriate in a foolish, irra- 
tional, and extravagant manner, and not with the common sense 
that it has applied to all other classes. Social law and order has 
passed by the inebriate, refused to properly classify this species of 
the genus homo, simply regarding him as a social outcast and decidedly 
as a " persona non grata.'' He was the social problem of the past; 
he is the social problem of the present ; he will be the social problem 
of the future, unless a modicum of common sense is exercised in 
regard to his care and control. 

74 



THE ALCOHOLIC PROBLEM. 75 

It is true that the moralist and the reformer by threats attempt 
to frighten him into sobriety, or by kindly acts and the instilling 
of hope try to lead him to a better life. 

The law brands him as a criminal, and punishes him by fine and 
imprisonment, while public sympathy and interest may be totally 
indifferent or divided between the reformer and the law, as a rule 
the preponderance of sentiment being in favor of the latter. 

It is the old story, a " twice told tale" with which you are perfectly 
familiar. You can not secure for the inebriate either public interest 
or legislation, which, after all, is public sentiment in the concrete, 
along the usual lines that affect other social conditions. Such efforts 
will fail as far as the inebriate is concerned. 

Therefore those who are interested in the welfare of the pauper 
inebriate — for my remarks have principally to do with that class — 
will waste their time and energies if they plead along sympathetic 
lines only. I do not mean that a plea on a moral, spiritual, or humane 
basis will not arouse a Christian public. But when you face the 
average taxpayer, or the " committee on ways and means" of a legis- 
lative body, an argument based on moral, spiritual, or humane 
grounds would simply fail. The only argument you can bring for- 
ward that would be effectual under these conditions is one based on 
financial considerations and on dire and urgent public necessity. 
You must appeal as a political economist and show by fact and figure 
that which is good business policy and that money is saved to the 
State or municipality, and consequently to the taxpayer. 

The most powerful appeal that you can make to the average tax- 
payer is any plan that will lower the prevailing tax rate; and there- 
fore if we are at all interested in the inebriate, and desire action on his 
behalf, and are wise, we will approach the public as taxpayers, and 
then by force of public sentiment, thus enlightened by facts and 
figures, and stimulated by self-interest, compel favorable legislation 
on behalf of the inebriate. In fact, this is our only resource. But the 
public must first be interested. The demand for economy must have 
always come first from a tax-ridden public. Economy, as a rule, does 
not begin with legislators. Public sentiment must, as it always has, 
compel legislative action in any direction. With these prefatory 
considerations let us consider the relation of the inebriate to the 
municipality and the State from an economic point of view. 

We can readily demonstrate that the present method of dealing 
with the pauper inebriate is nonpunitive, nondeterrent, nonreforma- 
tory, rather the reverse, not checking, but promoting intemperance, 
pauperism, disease, and crime, and all their attendant and secondary 
evils, and, besides, all this is enormously expensive. 

The public and the legislators, who but reflect public sentiment, are 
laboring under a delusion ; in their own inner consciousness they have 
worked out, as they think, the whole problem of inebriety, but their 
conclusions are erroneous because their logic is faulty and based on 
wrong premises, and therefore the ultimate end of their deliberations 
worse than useless. 

Let me again call your attention to and emphasize the fact that 
inebriety is the fertile source of crime, pauperism, insanity, and dis- 
ease. At least four-fifths of the criminals and degenerates of a com- 
munity may, according to English statistics, be traced to this cause 
either directly or indirectly. Facts go to demonstrate that it is an 



76 



THE ALCOHOLIC PROBLEM. 



important factor as a cause of suicide, disease, accident, and adult 
male death from accident, and either directly or indirectly explains 
the mortality statistics of our great centers of population, especially 
among the adult male class, in excess above the normal death rate in 
an ordinary sober community. 

Looking at the financial side of this problem we find that 50 per 
cent of the municipal expenditure for our police departments is simply 
for the arrest of the drunken population of cities. Nor does this 
include the expense of sheltering and caring for same in prisons, peni- 
tentiaries, and almshouses, or other corrective or charitable institu- 
tions, one-third of their inmates on an average being either directly or 
indirectly of the inebriate class. 

These are some of the direct fruits of inebriety. We garner the 
fruit, but we do not cut down the tree. We do not go to the root 
of matters. Nay, our present method promotes growth; we cultivate 
that which we ought to destroy, and we are rewarded — or shall we 
say punished? — by an abundant crop of evil, the result of the irra- 
tional and unscientific method now in vogue of dealing with the 
inebriate. 

First, then, let us call attention to the manner in which the police 
department carry out the laws enacted by our legislators and admin- 
istered by our magistrates; laws which deal with the inebriate in a 
most unscientific, irrational, and expensive manner; laws which the 
legislature have passed, but for which the public who elect them are 
primarily responsible, and the genesis of which is a fundamental 
error as to the nature of inebriety and proper methods for the care 
and control of the inebriate. 

Let me point out the fact that arrests recorded on the police blot- 
ter are cases, not individuals. Thus, if 10,000 cases of arrest for 
drunkenness are recorded, we find it may represent certainly one- 
half or even less of individuals. In an article entitled "The pauper 
inebriate — cases versus individuals," read and published in 1897, we 
pointed out this glaring discrepancy, quoting from the experience of 
others on this subject, and particularly from an article published some 
years previously by my father, the late Theodore L. Mason, M. D., 
on this subject, entitled " Inebriety a disease." 

In the " report of the advisory committee on the penal aspect of 
drunkenness," appointed by the mayor of Boston, 1898, the follow- 
ing statistics point out this evil: 

Former commitments of prisoners committed for drunkenness to all penal institutions in 
Massachusetts for the year ending September 30, 1898. 



Whole number of commitments 

Number of first commitments 

Total recommi tments 

Number of times previously committed: 

One time 

Two times 

Three times 

Four times 

Five times 

Six to fifteen times 

Sixteen to thirty times 

Thirty-one to fifty times 

More than fifty times 



Number. 


Per cent. 


20,222 
8,794 




43.46 


11,439 


56.54 


2,113 


18.47 


2,415 


21.11 


1,524 


13.32 


1,021 


8.92 


816 


7.13 


2,701 


23.61 


689 


5.58 


160 


1.38 


50 


.43 



THE ALCOHOLIC PEOBLEM. 



77 



Statistics relating to persons sentenced to Deer Island (one of the 
penal institutions of Boston) showed that there were 8,447 committals 
for drunkenness, the report stating that "this number represents, 
however, but 5,444 individuals; consequently 3,003 were for offenses 
repeated within the year." 

It will be noticed that in all the penal institutions the recommit- 
ments were considerably over one-half of all the first commitments. 

The fact is also evident that where there were longer terms of 
imprisonment, as at Deer Island, the ratio of recommitments was 
less than those institutions in which the period of imprisonment was 
shorter, a fact essentially in favor of the longer term of commitments 
as opposed to the shorter term. 

The Boston statistics also show the relation between individuals 
and cases, to which we have referred. Thus, 11,439 individuals were 
recommitted from two to over fifty times each, making at the lowest 
or minimum estimate a total of over 50,000 rearrests in excess of first 
commitments, represented by the above number of individuals at 
various periods during their inebriate career. When we consider 
that the cost to the city of Boston was $8 for each case committed, 
the enormous and useless expense to the municipality is at once 
apparent. Nor must we forget, in addition to this direct and useless 
expenditure, this drifting population of drunkards during their life 
history swelled the records of the many asylums, hospitals, and 
charitable and penal institutions, under different aliases, and when 
at large imposed on the charity of an indulgent public, thus contribut- 
ing in many ways and at all times to the crime, pauperism, and dis- 
ease statistics of our great centers of population. The following table 
shows the number of prisoners and the number of times committed 
according to the statistical report of the department of correction 
of the city of New York for all causes : 

Number of times committed. 

















o 


o 


o 


o 


o 
























0) 




a 


d 

* 


o 

a> 


B 

o 


> 


a 

O 

►4 




e 


3 


o 

o >> 

o 


> 

o £? 




o 


H 


&H 


Ph 


Ph 


GQ 


H 


E-t 


B 


pq 


Pm w 


Males 


10, 325 
4,133 


694 
670 


143 
547 


86 
258 


47 
240 


187 
252 


32 

47 


11 
4 


26 
3 


9 
4 


21 


Females 


4 






Total 


14, 458 


1,364 


690 


344 


287 


439 


79 


15 


29 


13 


25 







Males 11, 581 

Females 6, 162 



Total 17,743 

Of these prisoners 5,568 were committed for intoxication, 3,233 
male and 2,335 female. We can safely assert that the recommittals, 
varying from one to seventy-five times, were for intoxication, with 
or without other misdemeanors, thus equaling if not exceeding the 
Boston statistics in this particular. 

All statistics should have the individual record. It would simplify 
the record of the police department of our cities if such records would 
classify individuals as individuals and not individuals as cases. We 



78 



THE ALCOHOLIC PKOBLEM. 



would then have the advantage of an individual record, and be able 
to follow the prison and penitentiary record .of the individual in this 
particular. 

The following table will explain itself, and show why the same 
individual is so often arrested and recommitted during the year. It 
will be observed that the shortest term, three to five days, tallies 
almost with the number of prisoners committed for intoxication only : 

Terms of commitment of prisoners admitted during the year 1902. 





Three to 
five 
days. 


Ten 
days. 


Fifteen 
days to 

one 
month. 


Two to 

three 
months. 


Four to 

five 
months. 


Six 
months. 


Male 


3,835 
1,945 


2,124 
1,601 


918 
309 


1,641 

857 


3,052 
1,444 


11 


Female 


6 






Total 


5,780 


3,725 


1,227 


2,498 


4,496 


17 







Males 11,581 

Females 6, 162 

Total 17,743 

Ten thousand seven hundred and thirty-two committed for thirty 
days or less, and 9,505 of these for ten days or less. 

These frequent recommittals for short periods are for repeated 
offenses by a comparatively few persons during the year, and for 
intoxication only, or the same associated with petty crimes and mis- 
demeanors, the result of the intoxication. 

A little study of these statistics will explain themselves, even to 
the most casual observer. We will now call attention to the civic 
cost of drunkenness, and refer again to the Boston statistics: 

The cost of drunkenness, and incomes from fines for this offense during the year 1898. 

It is estimated that the cost of making arrests for drunkenness in Boston 
is equal to one-eighth of the total cost ($1,683,957.97) of the police de- 
partment; with 26,157 arrests for drunkenness at $8.04 each, the total 
cost to the city was $210, 494. 74 

There were 8,447 committals to the house of correction at Deer Island for 
drunkenness, and the aggregate of the time served was 459,252 days, 
equivalent to 1,258.224 years; the per capita cost of maintenance was 
$84.70, making a total equal to 75 per cent of the whole cost, or Ill, 212. 71 

There were 107 committals to the house of correction at South Boston for 
drunkenness, and the aggregate time served was 13,460 days, equivalent 
to 36.877 years. The per capita cost of maintenance was $124.47, mak- 
ing a total equal to 7 per cent of the whole cost, or 4, 590. 08 

There were 1,877 committals to the Suffolk County jail for drunkenness, 
and the aggregate of the time served was 26,097 days, equivalent to 
71.50 years; the per capita cost of maintenance was $184.69, or 13, 205. 33 

Total cost of drunkenness, in 1898 339,502. 86 

Income from fines 23,490.78 

Net cost of arresting persons for drunkenness and maintaining 
those committed to the penal institutions of Suffolk County 
in 1898 316,012.08 

In addition to the direct expense of this class to the municipality 
we can only refer to the burden which is imposed on charitable 
organizations and individuals, and the misery, waste, and destitution 



THE ALCOHOLIC PROBLEM. 



79 



which follow on their trail, and which has been enacted under a 
roving commission practically furnished to them by a nearsighted 
and extravagant municipal policy, which has inaugurated and 
sustains the miserable farce of fines and short-term commitments, a 
constant menace and expense to the community, a method of dealing 
with this class which we have stated is neither deterrent nor reforma- 
tory, but positively the reverse. 

The report of the New York department of correction states: 

The total number of prisoners committed for the year 1902 was 25,064. The greater 
part of these, 20,358, were confined in the workhouse, Blackwells Island, and the 
branch workhouse, Harts Island. The remaining prisoners were in the following 
institutions: New York County Penitentiary, Blackwells Island, 1,172; Kings County 
Penitentiary, Brooklyn, 2,534. The population at the workhouse is a constantly 
changing one, as the inmates, who are only charged with misdemeanors, are com- 
mitted to serve sentences varying from a few days to six months. The largest number 
of prisoners last year were committed for the first time, but some have been committed 
as many as 75 times. 

The workhouses received the majority of the committals made 
during 1902. The statement that the committals range from a few 
days to six months, and that while the majority were committed for 
the first time some were committed as often as seventy-five times, is a 
record that tells its own story, and has short-term committals for 
intoxication written all over it. It may be mentioned here that the 
fines collected for intoxication or other misdemeanors in New York 
State meet a certain proportion of the expense incurred in the board 
and maintenance of the prisoners in the district prisons, city prison, 
workhouses, and penitentiary, but were a mere trifle as a contribution 
to the total cost of arresting and committing the inebriate population 
of our city. 

An unfortunate aspect of the fine system is that in a large number 
of instances the fine is paid by the industrious, sober, and self- 
sacrificing portion of the community, and not by the drunkard 
himself; so that the fine is literally a tax imposed on the family or 
friends of the inebriate, who, having suffered in many ways for his 
misconduct, suffer in this respect also. 

It may be said that at least one-third of the prisoners in our 
prisons and penitentiaries are committed for habitual intoxication. 
This would be a low estimate if we considered alcohol also as an indi- 
rect cause of the crimes and misdemeanors for which they were commit- 
ted, irrespective of committals for that of drunkenness. We submit 
a statistical table of leading American cities showing the average 
number of arrests for intoxication in these cities during the year 1902: 

Statistics of leading American cities, 1902. 



Cities. 



New York. .. 

Chicago 

Philadelphia . 
Boston 











June 30, 


January 1, 
1903, popu- 
lation. 


Total 


Average 


Average 


1902, 


number 


annual 


annual 


average 


police 
force. 


cost of 
force. 


number 
of arrests. 


arrests 
for into£ 










ication. 


3, G82, 159 


7,707 


$11,500,080 


145, 164 


71,573 


1, 800, 000 


2,780 


3, 300, 000 


75, 000 


32, 4S2 


1, 335, 000 


2, 902 


2,500,000 


62, 000 


30, 428 


573, 879 


1,214 


1, 600, 000 


39, 078 


19,511 



Licensed 
retail 
liquor 

saloons. 



10, 821 

6,740 

1,737 

980 



80 THE ALCOHOLIC PROBLEM. 

It will be noted that the statistics for arrests for intoxication, also 
number of licensed saloons, is six months earlier than the other 
statistics, but the record is near enough to be approximately correct. 

It will also be noted that about one-half the total arrests for all 
causes are for intoxication. 

It will also be noted that the number of arrests for intoxication pro 
rata to each member of the police force is 10 or + 10. 

According to the Boston statistics for 1898 it is estimated that the 
cost of making arrests for drunkenness, irrespective of board and 
maintenance, was one-eighth of the total cost of the entire police 
department. 

Applying the same ratio to the average annual cost of the police 
department of cities we can ascertain the exact cost to each city for 
simply the arrest and committal of its drunken population. 

When we ascertain that 50 per cent, if not more, of the average 
arrests for intoxication are rearrests and recommittals in the same 
year, we can readily estimate the amount each municipality pays for 
rearrests and recommittals of intoxicated persons, which, on the 
above basis, would be one-half of one-eighth, or one-sixteenth of the 
total cost of our police department of each city. 

In other words, if the individual was arrested once annually instead 
of several times the expense to the city in the arrest of its drunken 
population would be reduced one-half. 

Those interested can apply this statement to the statistics of cities 
already given. 

Thus, New York would have saved in 1903 one-sixteenth of its 
total police department expenses, or $722,917, and Chicago, Phila- 
delphia, and Boston a proportionate amount. 

We do not estimate the increased expense of caring for short-term 
prisoners in the prisons and penitentiaries as compared with the 
greater advantage and less expense of caring for long-term prisoners, 
nor the fact that short-term prisoners can in no wise be made self- 
supporting when the term of commitment does not average ten days 
in the great majority of cases. The whole question then turns on 
the short-term commitments and the fine system, which practically 
results in the majority of cases in the short-term commitment of a 
few days. Abolish this worse than useless system by repealing the 
laws under which it is carried on and the problem will be solved. We 
are now dealing with simply a matter of dollars and cents, the financial 
aspect of the question. We shall refer elsewhere to the iniquity of 
the short-term sentence and fines, and its pernicious results. 

The attitude of the law and the police departments of our great 
cities toward the pauper inebriate, who constitutes so large a pro- 
portion of the class which come under their control, is clearly shown 
in these statistics. 

It will be observed that the total recommitments greatly exceed the 
total first commitments, and average more than one-half of the whole 
number of commitments for intoxication, and that the total arrests 
for intoxication constitutes at least one-half of the total number of 
arrests for all causes ; and this percentage applies to all the cities of the 
first class, whose statistics we have tabulated. 

The expense of these unnecessary recommittals in the case of 
individuals is readily shown, and the number of times each individual 
was recommitted. According to the Boston statistics the arrest of 



THE ALCOHOLIC PROBLEM. 81 

single individuals for intoxication varied from 2 to 50 times and over, 
while according to the New York statistics the number of arrests of 
individuals varied from 2 to 75 times. We are assured that from 
15 to 20 times is not an unusual record in a single police court for the 
same individual, who may have passed in his inebriate career through 
several police courts in the same or other cities, and counted in his 
institutional itineracy for many cases on the blotters of many police 
stations. It would be extremely interesting to follow the life record 
of one of these "rounders," or itinerant drunkards, and trace him 
through our various penal and charitable institutions, and then sit 
down and count the cost of that single individual to the State and 
indirectly to the taxpayer, not only from a financial standpoint but 
from every other aspect that involves pauperism, disease, and crime. 

We can not condemn too severely the miserable method under 
which our police magistrates deal with our drunken population. We 
refer to the law of fines and short-term imprisonment, a system that 
manufactures the " vagrant drunkard/ 7 the " jail bird," the " itinerant 
drunkard," or, in the language of the police, "the rounder." No 
wonder our police courts have been aptly styled "schools of vice." 

In an address of the English Howard Association, on the treatment 
and prevention of crime, they say that the system of repeated short 
sentences "is intolerable." That — 

Repeated sentences of fortnight upon fortnight, and month upon month, add to the 
difficulties of prison management, and greatly demoralize the delinquents and their 
companions as a class. 

Where a single short sentence fails to deter, it is a proof that public morality and 
economy alike require the infliction of a longer reformatory discipline, protracted until 
criminal habits are effectually subdued. 

An eminent authority has recently remarked that " magistrates who repeatedly pass 
demoralizing short sentences are themselves promoters of crime." 

Speaking of the evils of the present system the committee appointed 
to report on the penal aspects of drunkenness in Boston characterizes 
the method as follows : 

In fact, short of a public bounty on drunkenness it is doubtful whether human inge- 
nuity could devise a system which would be as wasteful and demoralizing as the 
present one. 

The same report characterizes the "rounder" as the product of the 
present method, as follows: 

Let no one misunderstand this pitiful wretch — the "rounder," physically and 
morally debauched, is the product of the existing system. He represents the closing 
act in a moral tragedy, in which society plays the villain in the guise of justice and law, 
and the poor man is the victim, with the imprisonment of a hitherto respectable first 
offender for the first official act in the tragedy; the corrupt and compromising associa- 
tions of the prison, for the second act; tainted reputation and decreased earning capac- 
ity, for the third; discouragement and relapse, for the fourth; and so on to the end of 
the miserable business — first moral and then physical death. 

In further confirmation of these facts I desire to present portion of 
an article on the care and treatment of inebriates, by the late Rev. 
J. Willett, superintendent of the Inebriates' Home for Kings County, 
and published in 1881. He thus writes concerning the "vagrant 
drunkard" or "rounder," or "prison class" of inebriates: 

I only wish we had the means and the machinery at our disposal to take hold of the 
prison class. I refer more particularly here to those who have been committed and 
recommitted to prison from one to one hundred times, in order to save them from spend- 
ing the balance of their lives in revolving from the barroom to the bar of justice, and 

S. Doc. 48, 61-1 6 



82 THE ALCOHOLIC PROBLEM. 

from thence to the prison cell. When discharged from jail, ragged and forlorn, they 
find themselves friendless wanderers in the streets, shunned by every passing stranger. 
I am aware that the popular cry is " Let them go to work, " but who will employ them, 
when they are everywhere shunned as if stricken by pestilence? Besides all this, they 
are physically broken down through the effects of bad liquor and starvation prison diet. 
The majority of their numbers are mere wrecks of humanity, and are regarded as fair 
game for the policeman to hunt up and chase down for the purpose of swelling the 
annual return of the arrests made by him, with a view to promotion to a higher grade. 
On each succeeding recommitment of the vagrant drunkard to the jail, the daily charge 
for his subsistence goes to swell up the sheriff's board bill, the profits on which in some 
counties may be safely estimated as more than 100 per cent. Thus the vagrant 
drunkard is practically reduced to a mere chattel, the legally recognized stock in trade 
of the police force and his jailers. 

But we must not forget that we are dealing with facts and figures, 
and talking not to the heart but the pocketbook of the taxpayers. 

Fifty per cent of all arrests in our great cities are for intoxication, 
and the arrests of 50 per cent or more of this class are rearrests, 
often with a few days only between each arrest, so that the same indi- 
vidual is arrested, committed, and released every few days. 

The cost to the city of Boston in 1898 was $210,494.74 for 26,157 
arrests, at a per capita cost of $8.04 each. One-half or more of these 
arrests were rearrests, retrials, recommittals of persons who had been 
arrested from two to fifty times each. 

The arrests for intoxication in New York City for year ending June 
30, 1902, were 71,573, or over one-half of the total arrests; and fully 
50 per cent of these were rearrests and recommittals of the same per- 
son, who had been arrested and committed from two to seventy-five 
times each, and this average will pertain to all the great cities and 
centers of population. It may be said that half the time of the police 
department of our great cities — its patrolmen in arresting, its police 
magistrates in committing, its prison and penitentiary officials — is 
in controlling and caring for persons who are arrested many times 
during the year. If the drunken population of our cities, the class 
and individuals who are well known to the police, could be arrested 
and incarcerated only once annually, the expense of the police depart- 
ment of said cities would be cut down one-half, the business of which 
is due largely either directly or indirectly to alcohol. 

In the recent words of a police magistrate, "Find an antidote for 
intoxication and one-half of the business of the police courts would 
vanish," and we would say, shut up the "rounder," the itinerant 
drunkard, and the problem is solved; which will not only relieve our 
overburdened police courts but reduce the average tax rate very 
materially; lessen also the strain upon our various charitable and 
correctional institutions, which care for the "rounder" under various 
aliases in his institutional itineracy, to say nothing of the persistent 
and great demand from which a generous and sympathetic public 
would be relieved. 

The cost of handling the drunken population of Boston in 1898 was 
one-eighth of the total cost of its police department, or $210,494.74. 
Fifty per cent of this expense was for unnecessary recommittals, as 
has been already asserted. 

On the same basis it cost New York City about $572,584 to arrest 
its 71,573 cases of intoxication. Fifty per cent of this expense was 
for recommittals, and was also unnecessary. 

This record will grow as our urban population increases. 



THE ALCOHOLIC PEOBLEM. 83 

During the milder seasons of the year our suburban population feel 
the burden and annoyance of the genus known as tramps, who are 
simply members of the great army of the drunken population of our 
cities on its annual pilgrimage. But although this may afford slight 
and temporary relief for our cities, the question is one for our great 
civic centers, on whom the care and expense of this class primarily 
and permanently rests. 

You can perceive that the whole aim and drift of this paper is in 
favor of the long-term commitment, not less than six months in any 
case, and the accumulative sentence of one, two, or three years in 
incorrigible cases or repeated offenses. 

Long sentences are opposed to the miserable present system of short- 
term imprisonment, a few days, on the average, in the larger propor- 
tion of cases, and the fine, which is seldom paid, and so is practically 
a short-term commitment. 

The " long-term commitment," with a judicious use of the " pro- 
bation method," as practiced and recommended by the Boston 
authorities, and the lt parole system," as used in our penal institu- 
tions and insane asylums, would solve the problem of the civic care 
of the pauper inebriate and lessen both the state and municipal 
expenses as to his control. 

I can not close this paper without quoting from the following argu- 
ment in favor of a long-term commitment for the chronic pauper 
inebriate. This statement is not based on the fact that it is a method 
of economy alone, but also that it is the only true method of reforma- 
tion, the only one that can benefit the drunkard. This report was 
made some years since; and now we advocate separate institutions 
for the pauper inebriate, isolation, segregation, separation from all 
other classes that are wards of the State, whether insane or criminal. 
With neither of the classes can the inebriate be properly placed and 
be successfully treated. Moreover, the earning capacity of the inebri- 
ate is on a better scale than that of the criminal, certainly equal to 
it, and vastly superior to the average resident of the almshouses or 
the insane asylum, so that he can under confinement be made to 
administer to his self-support. With this explanation we submit 
the article published some years since in a paper written by my 
father on this all-important subject. As the article gives in a con- 
densed form the points I wish to present and urge, I will ask the 
privilege to quote it at length : 

NECESSITY FOR LONG TERM. 

A great deal has recently been written and said concerning the expediency of 
utilizing the chronic drunkard by establishing workshops in connection with our 
prisons, in which he may be able to contribute something toward his own support 
while in custody, and even to lay up a little capital to start with when released at the 
expiration of his term. 

The experience of those thoroughly acquainted with the management of penal 
institutions is that it is utterly impossible to utilize the drunkard who is constantly 
being recommitted to the jail or the penitentiary unless, after repeated offenses, he 
be committed for a term of years. On this important subject we can not do better 
than to quote from an annual report of Gen. Amos Pilsbury, then warden of the 
Albany Penitentiary. In speaking of this subject he says: 

"It is for the lawgiver to determine whether imprisonment in the penitentiary is 
the best mode of punishment for intoxication in any case; but if it is designed to 
have any effect in curing the vice of intemperance, a term of six months should be 
imposed in all cases of second or further convictions. 



84 THE ALCOHOLIC PROBLEM. 

"The truth is that nothing short of a direct interposition of Divine power can per- 
form the miracle of suddenly converting and turning men from the error of their 
ways. Human agencies can only hope to accomplish the work of reform by retain- 
ing the subject under their operation until the power of old evil habits shall have 
been weakened by disuse, and new and good habits of sobriety and industry shall 
have been firmly acquired." 

In a report of the board of state prison inspectors (whose offices have been abol- 
ished under the new constitution) we find the following language on this subject: 

"For the large class of convicts having sixty or less days to serve, the superin- 
tendent can obtain little or no remunerative employment, so much time being 
required in these cases for the necessary instruction as to leave an employer small 
prospect of a compensating gain. It follows, as your honorable body will readily 
perceive, that convicts of this class not only fail to indemnify the penitentiary against 
the cost of their own support, but become, for the most part, a constant drain upon 
the productive labor. 

"But it must be remembered, moreover, that many of those short-time men are 
committed to the penitentiary during the year over and over again, deriving them- 
selves nothing whatever from the transient suspensions of their liberty, while inflict- 
ing upon the resources of the institution a steadily growing pecuniary loss. 

"Besides, this class of subjects make heavy demands on the time and the atten- 
tion of our physicians, and convert our hospital in too many cases into a place of 
recovery from attacks of delirium tremens or other consequences of habitual intem- 
perance and evil habits." 

The consensus of expert opinion is then in favor of " long-term com- 
mitments/' "the accumulative sentence," with the judicious use of 
the " probation" method and the "parole," all of which is diamet- 
rically opposed to the present system of "short commitments and 
fines," which are neither punitive, deterrent, or reformatory, but 
rather the reverse, as has been said, promoting intemperance, pauper- 
ism, and crime, as well as more than doubling the municipal expense 
in the care of the pauper inebriate. 

We submit to the taxpaying and tax-ridden public, and indirectly 
to our legislators, the proposition: That the money thus worse than 
wasted in the continual arrest and rearrest of this class could be more 
properly and satisfactorily spent in the care and control of the pauper 
inebriate in reformatory institutions, which could be erected and 
maintained largely by the money so uselessly squandered by the 
present method, and not only provide for the maintenance and con- 
trol but the reformation of this unfortunate class. A consummation 
devoutly to be wished for, but not possible under the present system. 
And, besides all this, relieve our police magistrates and police force of 
half their present duties, involved in the ever-increasing burden which 
the constant arrest and commital of this class entail on our police 
courts, and also relieve our various penal, charitable, and correctional 
institutions from the same individuals, who, under various "aliases," 
over and over again pass through their wards during their itinerancy, 
which often involves a life record. We appeal to this association as 
we do to the medical profession throughout the land, to inaugurate 
and stimulate all legislative action that shall better the care, and 
especially the control, of the pauper inebriate, and give him an equal 
chance at least with the other wards of the State, and thus help to 
solve a problem that has agitated the public and puzzled legislators 
and burdened communities from the earliest ages of civilization. 
We believe the solution of the problem will be found in following the 
advice and opinions of those experts whose experience we have 
endeavored to present in this paper. 



PAPERS DISCUSSING THE GENERAL AND SPECIAL FORMS OF 
TREATMENT FOUND MOST AVAILABLE IN THE PRACTICE. 



85 



\ 



QUESTIONS OF DIET IN THE TREATMENT OF INEBRIETY. 



By J. H. Kellogg, M. D., Battle Creek, Mich. 
Superintendent of the Battle Creek Sanitarium. 



The marvelous progress which has been made in scientific medicine 
within the last twenty -five years, especially through the aid of the 
physiologic laboratory, has wrought a great revolution in the views of 
medical men respecting the value of alcohol in health and disease, as 
well as in relation to many other medical questions. The purpose of 
this paper is to sum up in a brief way the present status of this ques- 
tion as viewed, not from the empirical, but from the scientific stand- 
point. 

As regards the physiologic effects of alcohol, the discussion has 
practically been closed. Experiments upon both human beings and 
lower animals have been so greatly multiplied within the last few 
years that the effects of alcohol upon the healthy animal organism are 
now as well understood as are the physiologic effects of opium, strychnia, 
and other drugs in common use, and the experimental method has 
been brought to such a state of perfection that there is no opportu- 
nity left for divergence of opinion. 

That alcohol is a poison to all living organisms, both animal and 
vegetable, is no longer disputed. It is a waste or excretory product 
of the yeast fungus, and is so poisonous to the yeast cell that 1 part in 
1,000 in solution enormously lessens the growth of yeast. Numerous 
experiments, the details of which may be found in the report of the 
committee of fifty, have shown that alcohol, even in very small doses, 
is also poisonous to the higher organisms. For centuries the erro- 
neous belief has prevailed that while alcohol was poisonous in large 
doses, it was nonpoisonous, even a food, in small doses; but the more 
refined methods of observing vital phenomena, and the development 
of a more perfect laboratory technique, have shown that the so-called 
physiologic effects produced by small doses of alcohol are merely 
defensive efforts on the part of the body, the result of the resistant 
action of the tissues toward a recognized poison. This is clearly 
evidenced if we note the effect of alcohol, even in small doses, upon 
increase of secretion, but the increased secretion is chiefly mucous, 
showing that the purpose of the secretion is to protect the tissues 
against the irritant effect of the drug. Alcohol, when introduced 
into the stomach, as shown by Pawlow, produces an abundant flow 
of mucus, and also stimulates the formation of acid, but remains 
without action upon peptic glands. When this action is many times 
repeated the final result (Wood) is obliteration of the peptic and acid- 
forming glands and chronic gastric catarrh, the result of the defensive 
hypertrophy of the mucous glands. 

87 



88 THE ALCOHOLIC PROBLEM. 

John Hay (Lancet, June 12, 1904) attributes the stimulant effect 
of alcohol wholly to its reflex action resulting from irritation of the 
buccal, esophageal, and gastric mucous surfaces. He asserts that 
alcohol in very small doses has no effect upon the heart, but that 
large doses enfeeble its action through producing a toxic effect upon 
the muscular protoplasm. 

The supposed stimulant effect of alcohol has gradually evaporated 
under the sunlight of modern research until it has been reduced to the 
mere temporary irritation produced by the contact of alcohol with the 
nerve endings in the mucous lining of the stomach. The exhilaration 
following a moderate dose of alcohol is due not to stimulation, but to 
the narcotizing effect of the alcohol upon the vaso-motor and inhibi- 
tory centers, the abolition of the sense of fatigue through the paralyz- 
ing of the controlling centers, and the momentary flooding of the 
brain with blood through the paretic dilatation of its nutrient vessels. 

The toxic influence of alcohol upon living tissues is well shown in 
the fact cited by Metchnikoff (The New Hygiene), who has clearly 
shown that alcohol lessens immunity to a marked degree. Abbott, 
Metchnikoff, and many other observers testify that alcohol lessens 
vital resistance as well as the development of immunity. This has 
been shown with reference to the streptococcus and numerous other 
pathogenic bacteria. 

Tiegl has shown by eighty-six experiments upon human beings that 
alcohol, even when given in moderate doses, invariably produces a 
lowering of the body temperature, the amount of temperature de- 
pression being almost in direct proportion to the amount of alcohol 
administered. This fact, according to Wood (Therapeutics, Materia 
Medica, and Pharmacology), is due to the toxic effect of alcohol in 
checking metabolism. 

Harnack and Laible, from their studies of the effects of small doses 
of alcohol on the animal organism, reached the conclusion that under 
the influence of alcohol there is not only an increase in the amount 
of heat radiated, but a simultaneous decrease in the amount of heat 
produced. 

Modern arctic explorers invariably exclude alcohol from their daily 
ration, basing their action on the result of experience as well as those 
of laboratory research. This fact is one of tremendous importance, 
for if there are conditions of any sort which would seem to afford a 
favorable opportunity for alcohol as a really economic source of 
energy, it would seem to be those to which the arctic explorer is 
exposed. 

The toxic effects of alcohol are shown in a very striking way by its 
influence in hindering the formation and accumulation of glycogen in 
the liver. The storage of glycogen in the liver is one of the most 
important means of defense against bacterial infection. Any inter- 
ference with this function lessens resistance to infection. Salant's 
experiments upon rabbits show conclusively that alcohol hastens the 
disappearance of glycogen by disturbing the hepatic function, just as 
do other toxic agents, as shown by Roger. 

Another and more recent charge against alcohol is that it encour- 
ages intestinal auto-intoxication. The observations of Combe, Tis- 
sier, Metchnikoff, Von Noorden, Escherich, and numerous other 
authorities, have shown us the enormous role played by intestinal 
auto-intoxication in both acute and chronic disorders. Dana pointed 



THE ALCOHOLIC PKOBLEM. 89 

out more than a dozen years ago the probability that most nerve 
degenerations are the result of the action of toxins absorbed from the 
alimentary canal. MetchnikofT has shown that arterio-sclerosis and 
premature senility are chiefly due to this cause. Combe, of Lausanne, 
Arbuthnot Lane, of London, and others, have shown that neuras- 
thenia and many other chronic nervous disorders, various cachexias, 
skin maladies, and, in fact, the great majority of chronic disorders, 
are due to long-continued action of toxins absorbed from the alimen- 
tary canal. 

Hunt has made a series of observations which show that alcohol 
produces both an absolute and a relative increase of putrefaction 
products (ethereal sulphates) in the urinary secretion, and suggests 
that cirrhosis of the liver and alcoholic amblyopia are not due to the 
alcohol itself, but to the products of intestinal putrefaction, the 
amount of which is very greatly increased by alcohol. 

Boix ° published a dozen years ago the details of extended experi- 
ments upon rabbits and other animals, which clearly demonstrate the 
correctness of the view recently expressed by Hunt. 

The question of the food value of alcohol has been very warmly dis- 
cussed, especially since the experiments of Anstie. For a long time 
there was very great divergence in the results obtained by various 
experimenters, but within the last few years there has come to be a 
general concurrence in the opinion that alcohol can not be considered 
in any proper sense a normal foodstuff. The experiments of Atwater 
and others show clearly enough that alcohol is oxidized or metabolized 
in the body, but the same is true of opium and nearly all other organic 
substances. Anything that will burn will produce heat. Anything 
which will combine with oxygen under the conditions in which oxygen 
is found present in the body, whether in the alimentary canal, the 
blood, or the tissues, will give rise to heat; but this is not normal heat 
metabolism. The formation of heat in the body takes place in con- 
nection with cell activity. Heat may be considered as in large part 
a waste product. Muscular activity, gland activity, nervous activity, 
cell activities of all sorts in the body, are accompanied by heat pro- 
duction, and this is the normal way in which heat is produced. Iron 
filings introduced into the stomach will undergo oxidation and thus 
give rise to heat. This fact does not entitle iron filings to be classified 
as a food. The alcohol molecule is easily broken down when brought 
in contact with oxygen in the chemical condition in which it exists in 
the blood and other tissues. But the same is equally true of butyric 
acid, formic acid, strychnia, fusel oil, wood naphtha, sulphuric ether, 
and a thousand other organic compounds. Alcohol is less toxic than 
many of these substances, hence produces less disturbance in the 
vital economy, but this fact does not entitle it to rank as food. 

In a series of experiments Professor Atwater sought to prove that 
alcohol lessens the loss of protein and other elements of the tissues. 
This is one of the claims in favor of alcohol set up more than fifty 
years ago by William Hammond and others. He maintained that 
although alcohol may not be in itself a food it protects the system 
against all destruction of tissue and economizes the body resources. 
Atwater's carefully conducted experiments, however, absolutely 
destroy this ingenious apology for the use of alcohol. Atwater says 
in regard to the results of his experiments that in each case the sub- 

o Boix, Emile Theodore: "Le Foie des Dyspeptiques," Paris, 1895. 



90 THE ALCOHOLIC PROBLEM. 

stitution of alcohol for butter or sugar in the diet " resulted in a loss 
(or an increased loss) of body protein, which loss continued through 
the three days of the alcohol period.' ' a 

Commenting upon the results obtained, Atwater remarks that they 
may be " interpreted as indicating that the subject worked to better 
advantage on the ordinary diet than on the diet of which a part was 
alcohol." 

In the case referred to the average elimination of nitrogen in the 
nonalcoholic period was 15.5 grams daily. In the alcoholic period 
(each period lasted three days) the loss of nitrogen was 17.1 grams 
daily, and in the after nonalcoholic period 15.5 grams — a difference 
of 1.6 grams of nitrogen, the equivalent of 10 grams of protein, rep- 
resenting 14,000 calories (lesser) of energy. Allowing a possible gain 
of 1 per cent from the food from an improvement in digestion pro- 
duced by alcohol, though Atwater admits this to be very problemat- 
ical, there is on the whole a great loss, for an increase of 1 per cent 
in the utilization of the foodstuffs would amount to not more than 
2,500 to 3,000 calories — less than one-tenth the amount shown to be 
lost by the increased waste of nitrogen produced by alcohol. 

Notwithstanding his evident purpose to maintain the food value of 
alcohol, Atwater makes the following frank admission: 

In large quantities it is positively toxic, and may retard or even prevent metabolism 
in general and protein metabolism in particular. In small doses it seems at times 
to have an opposite influence, tending to increase the disintegration of protein. This 
action, though not conclusively demonstrated, is very probable. It offers a satisfac- 
tory explanation for the occasional failure of alcohol to protect protein, the assump- 
tion being that the two tendencies counteract each other. The only justification for 
calling alcohol a protein poison is found in this disintegrating tendency. 

This last admission by Atwater is highly significant. He frankly 
states that in large doses alcohol is " positively toxic," and demon- 
strates this by reference to the fact that it retards or prevents metab- 
olism in general and "protein metabolism in particular." Here 
Atwater cites as proof of its poisonous properties the very fact which 
has for nearly half a century been harped upon as evidence that alco- 
hol is a valuable remedy. 

In discussing this subject just thirty years ago the writer wrote as 
follows : 

But if alcohol did really hinder the destruction of the tissues, so as to prevent the 
natural process of disintegration, it would still be very injurious, for all the processes 
of life are dependent upon destructive change of tissue, and hence anything which 
would hinder this process would hinder vital action — would interfere with the life 
processes which are essential to the manifestation of life. 

During the thirty years which have elapsed since the preceding 
paragraph was written I have carefully watched the progress of 
physiologic experimentation in relation to alcohol, and have found 
no occasion for changing the position then taken, and am glad now 
to know that this position is backed up by so distinguished an inves- 
tigator as Professor Atwater. 

Having shown that alcohol is "positively toxic in large quantities," 
Atwater presents another fact which is equally important in this con- 
nection, stating that "in small doses it seems to have an opposite 
influence, tending to increase the disintegration of protein." So we 
have positive proof that small doses as well as large doses of alcohol 
are also "positively toxic." This Atwater recognizes in the admis- 

a Physiological Aspects of the Liquor Problem, Vol. II, p. 256. 



THE ALCOHOLIC PROBLEM. 91 

sion that a "justification for calling alcohol a protein poison is found 
in this disintegrating tendency." 

If, then, alcohol is a " positive poison" in large doses and a "pro- 
tein poison" in small doses, in what doses can it be called a food and 
under what circumstances can it be recommended for habitual or 
daily use ? 

In view of the above facts, the statement is amply justified that 
Professor Atwater's exhaustive experiments with reference to the 
influence of alcohol upon digestion and nutrition show its effects to 
be damaging rather than beneficial — 

(1) Because the effects of alcohol in increasing the palatability of 
the food nutrients were nil. 

(2) Because the loss of energy through the increase of protein 
waste under the influence of alcohol was ten to fifteen times greater 
than the possible gain from the influence of alcohol upon protein 
digestion. 

(3) In large doses alcohol diminishes metabolism, and hence hin- 
ders the use of the protein after it has been absorbed, while in small 
doses it increases protein waste, thus demonstrating itself to be in 
both large doses and small doses a protein poison, and hence in no 
sense, a proper nutriment. 

(4) Alcohol has no value as an aid to digestion in persons who are 
suffering from slow digestion, as in hypopepsia or hypohydrochloria. 
The experiments show simply the degree to which a healthy organ- 
ism may tolerate the introduction of this substance, a confessed 
poison, without grave interference with normal physiologic processes. 

The experiments made by Chittenden, referred to later, show most 
conclusively that alcohol, even in very small doses, interferes seri- 
ously with the digestive activity of the gastric juice which is already 
of inferior quality. The same fact has also been demonstrated by 
the writer in a series of experiments, the results of which will be 
detailed later. 

The influence of alcohol upon the inhibition functions is a question 
which has an important relation to digestion. 

Pawlow and his pupils have demonstrated the existence of a secreto- 
inhibitory influence controlling both the gastric glands and the pan- 
creas. The facts developed in these remarkable experiments are of 
such great importance in relation to this question that we will quote 
the exact words of the eminent investigator in the following para- 
graph : 

Our experiments, in which diseased conditions of the large or small stomach were 
experimentally provoked, have shown with great regularity that the first reaction of 
the peptic glands to a powerful and unusual influence consists in a marked depression 
of their activity, lasting for several hours, or even days. This depression is of a reflex 
nature. It is due to the influence of the inhibitory nervous system, which is thrown 
into activity by the more than ordinary degree of stimulation. When one, for instance, 
pours ice-cold water or a solution of nitrate of silver into the large stomach (experi- 
ments of Dr. J. C. Soborrow) the secretion which is subsequently produced by an 
ordinary meal is less than normal, more especially in the first hours. This happens 
not only in the large cavity, but also in the small, the walls of which latter at no time 
come into direct contact with the injurious substance. The thought suggests itself 
that as soon as the stomach encounters an unaccustomed stimulus the activity of the 
peptic glands is at once inhibited by means of a special reflex, whose object is to pro- 
tect the deeply lying cells still further against harmful influence. The only excep- 
tion to this is observed after the action of strong alcohol. When alcohol is poured 
into the large stomach an extremely free secretion of gastric juice begins from the 
small cavity. Conversely, by acting on the latter, the alcohol is also able to set up 
an abundant secretion in the large. 



92 THE ALCOHOLIC PROBLEM. 

Here we have the actual proof not only that alcohol may destroy 
through its narcotic influence the inhibitory control of the nervous 
system, as ordinarily exercised upon the gastric glands, but that it 
actually does this. After having established the fact that strong 
stimuli of every sort, thermal as well as chemical, have the uniform 
effect to lessen gastric secretion when brought into contact with the 
mucous membrane of the stomach, he calls especial attention to the 
fact that alcohol is the one and only exception to this rule. When 
introduced into the stomach it produces the very opposite effect, 
evidently through the destruction of inhibition. In this regard alco- 
hol behaves in the stomach as elsewhere in the body. No matter 
what the structure or organ with which alcohol is brought in contact, 
its influence is universally found to be inhibitory. 

For example, Nadler found that men on the verge of delirium 
tremens had a much shorter reaction time than healthy persons. 
Krapelin and others have also shown that under alcohol various ele- 
mentary mental processes are hastened. This fact, however, as 
observed by Abel and numerous other physiologists, does not prove 
that alcohol is a stimulant of the functions of the brain while a 
depressant of all other function, but is an indication of the paralyz- 
ing influence of alcohol upon the inhibitory functions upon which 
the regulation of the bodily activities ordinarily depend. It is just 
as important that the secretory activity of the stomach should be 
controlled by inhibitory centers as that it should be stimulated by 
excitory centers. If the excitory nerves were alone operative, then 
the stomach would become cataleptic, as James suggests in relation 
to the cerebrum; that is, the secretion of gastric juice, having once 
begun, would continue indefinitely. This is, in fact, the condition 
which does exist in certain cases of disease (gastro-succorrhea), in 
which, in the absence of all stimuli, the gastric secretion continues 
day and night without cessation, evidently because of the suspension 
of the normal control exercised by the secreto-inhibitory mechanism. 

Pawlow' s experiments show beyond chance for reasonable doubt 
that the effect of alcohol when applied to the stomach is to set aside 
a portion of this mechanism. The smaller the dose, of course, the less 
the effect. In a very small dose the organism might possibly be able 
to struggle against the toxic influence of the drug and so maintain a 
fair degree of control of the secretory process, and in a larger dose, the 
influence of the inhibitory nerves being wholly overcome, the result 
is, as Pawlow says, "an extremely free secretion of gastric juice." 

The fact that this secretion is observed in the small cavity of the 
Pawlow pouch, as well as in the large stomach, is an indication that 
the effect produced operates through the nervous system, and that it 
is not due simply to the local influence of alcohol upon the secreting 
cells with which it comes in contact. 

That it has a depressing rather than a stimulating influence is also 
shown by the fact that the universal effect of unusual stimuli upon 
the stomach is to produce suspension of secretion, rather than "an 
extremely free secretion." Although Pawlow makes no comment in 
relation to the mechanism of the effect observed from the use of 
alcohol, the conclusion we have drawn seems to be the only one pos- 
sible in relation to the influence of alcohol upon gastric secretion. 
This explanation also accords with the facts of clinical experience. 
The withdrawal of the normal controlling influence exerted by the 



THE ALCOHOLIC PKOBLEM. 93 

inhibitory nerves upon the gastric glands permits these secreting 
structures to exhaust themselves by excessive or continuous activity. 
While the first effect is to produce such an overaction as seems to 
greatly add to the individual's digestive capacity, the final result is 
premature exhaustion, and in the end atrophy and degeneration of 
the secreting structures of the stomach. This is the condition com- 
monly associated with gastric catarrh, so commonly found in free 
users of alcoholic liquors, viz, a hypersecretion and hyperchlorhydria, 
later hypochlorhydria, and later still apepsia or achylia. 

As additional evidence the writer desires to put on record a clinical 
fact drawn from his own observations and those of his immediate 
colleagues. The records of the clinical laboratory of which I have 
charge show the results of the quantitative analysis of gastric fluid 
obtained after an Ewald test meal in more than 30,000 cases. 

An examination of the histories of these 30,000 cases shows that 
1,500 of them, or 5 per cent, were habitual users of alcohol. Hyper- 
hydrochloria existed in 42 per cent, hypohydrochloria (HC1 less than 
0.180 per 100 c. c.) in 50 per cent, and normal acidity (acidity 0.180 to 
0.200 per 100 c. c.) in 8 per cent. 

Of the 1,500 who had been habitual users of alcohol, 65 were cases 
of inebriety and applied for treatment for this condition. 

A study of the findings in 1,000 cases, selected without reference to 
the use of alcohol, taken just as they come in our record books, gives: 

Per cent. 

Hyperhydrochloria 41. 8 

Hypohydrochloria 50. 2 

Normal 8. 

These figures are practically identical with those obtained from the 
habitual users of alcohol. If the habitual use of alcohol actually 
increases useful gastric secretion, we should certainly expect to find 
in a large number of users of the drug an average acid secretion con- 
siderably higher than that of nonusers. This is not the case. The 
figures obtained are practically the same for the two classes. 

The general effect of alcohol upon gastric secretion when studied 
statistically is more clearly shown in the 65 cases of chronic alcohol- 
ism. It would be naturally expected in these cases that the effects of 
alcohol would appear more prominently. A study of the chemical 
findings shows: 

Per cent. 

Cases of hyperhydrochloria 23 

Cases of hypohydrochloria 71 

Normal 6 

In comparing these figures with those found in most users of alcohol, 
we find the cases of hypohydrochloria increased more than 40 per 
cent, and cases of hyperhydrochloria decreased nearly 50 per cent. 
This is exactly what we should expect, for this result agrees exactly 
with the results which follow the long-continued administration of 
alcohol to animals. Friedenwald, in his experiments upon rabbits, to 
whom he administered alcohol in moderate amounts during long 
periods, observed u a gradual reduction in the amount of free HC1 in 
the gastric secretion. " He also observed hyperemia, increased secre- 
tion of mucus, and fatty degeneration of the epithelium of the gastric 
tubules (Welch). 



94 THE ALCOHOLIC PROBLEM. 

The above figures present overwhelming evidence that alcohol has 
no practical value in exciting gastric secretion, and that the ultimate 
effect of the use of alcohol is to lessen gastric secretion, and hence to 
impair digestive activity. 

Schmiedeberg, Bunge, and other investigators have shown most 
conclusively that alcohol is a depressant agent, lessening all those 
physiologic activities which are involved in oxidation and circulation, 
respiration, and body temperature. It is altogether inconsistent, then, 
to suppose that an agent which is a depressant everywhere else in the 
body becomes in the alimentary canal an excitant of normal activity. 
If we accept the views of Edkins, Starling, and Bayliss, that gastric 
secretion is carried on not under the direct influence of excitatory 
nerves, but rather as the result of the stimulating influence of gastrin 
or gastric secretion produced by the mucous membrane of the pyloric 
end of the stomach, and set free by means of dextrin, maltose and 
peptogen, and various other so-called peptogens, the influence of the 
secreto-inhibitory nerves in the control of the secretion becomes in 
the highest degree important, since it is only through inhibition that 
they exert whatever control can be exercised by the central nervous 
system over the secretory function of the stomach. 

The facts above stated and the conclusions drawn remain valid no 
matter which view of the mechanism of the secretion is adopted, or 
whether both these are correct, as has been suggested by Frouin 
(Lancet, August 19, 1905, p. 502). 

Singer, who experimented upon rabbits, claimed that if true this 
is another illustration of the effects of alcohol in paralyzing inhibitory 
nerves. In no other way could this increase of activity be accounted 
for, since it is well enough known that the direct influence of alcohol 
is to lessen muscular power or activity, as shown by the fact that so 
small an amount as half of 1 per cent applied directly to the heart of 
a frog produced decided diminution in its energy. It is true that the 
same apparent effect might be produced by stimulation, and if alcohol 
were known to be a stimulant this conclusion would be legitimate; 
but when the depressant and nonstimulating properties of alcohol 
have been so thoroughly established by a multitude of competent 
investigators in all parts of the world consistency requires that the 
phenomena following its use should be explained in harmony with this 
well-established fact, rather than in opposition to it. To assume that 
alcohol is capable of stimulating peristalsis by exciting muscular activ- 
ity is to deliberately contradict all the positive facts which are known 
in relation to its influence upon living tissues and vital functions. 

If it be argued that a depressant effect would act equally upon both 
the inhibitory and the excitatory nerves, so that no change in activity 
would occur, it is only necessary in reply to recall the fact that the in- 
hibitory influences are necessarily weaker than excitatory influences. 
The excitatory impulses are primary and essential to life, while the 
inhibitory influences exist merely as a modifying and controlling 
factor. Hence the presence of a paralyzing agent naturally makes 
itself felt more distinctly by its effects upon the inhibitory rather 
than the excitatory mechanism, unless applied with such vigor as to 
overwhelm and annihilate all nervous influence. 

Abel says, with reference to muscular action in general, that "both 
science and the experience of life have exploded the pernicious theory 
that alcohol gives any persistent increase of muscular power.' ' This 



THE ALCOHOLIC PROBLEM. 95 

principle must hold good in relation to the internal and involuntary 
muscular structures, as well as to the voluntary muscles. The experi- 
ments made by Hare and numerous other investigators upon the 
heart show this to be undoubtedly true. 

The experiments of Chittenden (Report of the Committee of Fifty) 
showed that while alcohol excites gastric secretion it diminishes 
peptic activity. He also noted that this effect was especially marked 
in cases in which hydrochloric acid was already feeble in character. 
This observation led me to make an experimental study of the effect 
of alcohol upon the gastric fluid obtained from the stomach after a 
test meal. The findings are decidedly interesting. 

In our laboratory we employ for testing the peptic activity of 
gastric fluids the method known as Mett's, which consists in dropping 
into a portion of the fluid a small glass tube containing coagulated egg 
albumen. The fluid is placed in an incubator for twelve hours at 
100°. At the end of this time the length of the column of albu- 
men which has been digested is measured. Normal gastric fluid 
should digest four milligrams of coagulated albumen in twelve 
hours. In employing this method it is very easy to determine the 
effect of alcohol upon the digestive activity of any given fluid and 
note the effect of different proportions of alcohol. For some weeks 
I submitted the surplus gastric fluid left after the ordinary tests to 
tests for determining the influence of alcohol, using alcohol in the 
proportion of 1 per cent, 5 per cent, and 10 per cent. The result was 
almost uniformly a lessening of the digestive activity in the gastric 
fluid. In the two cases in which the digestive activity seemed to be 
increased there must have been an error in observation. The effect 
of a 1 per cent solution of alcohol was not shown to be deleterious in 
every case, but the 5 per cent solution produced a very marked dimi- 
nution in digestive activity, and there were only a few instances in 
which the 10 per cent solution did not completely annihilate the 
digestive power of the gastric juice, even in cases in which it was 
unusually active. An interesting fact observed was that in cases in 
which the gastric juice was lacking in hydrochloric acid, showing no 
peptic activity whatever, but becoming active when hydrochloric 
acid was added, the addition of a 1 per cent solution of alcohol com- 
pletely annihilated digestive activity, when remarkably high figures 
were obtained before adding the alcohol. For example, in one case 
in which without acid the peptic activity was zero, but after the 
addition of acid 10 milligrams of albumen were digested in twelve 
hours, the addition of 1 per cent of alcohol completely stopped the 
digestive action. 

In view of the facts which are now known in relation to the influence 
of alcohol upon digestion, there seems to be left no ground upon which 
to defend the use of this drug as a gastric stimulant. Indeed, the 
effects of alcohol upon the stomach coincide precisely with the effects 
observed upon other functions. 

Alcohol when taken habitually gradually loses its effect upon the 
inhibitory nerves of the stomach, and so the apparently systemic 
effects first produced gradually disappear. 

Harm showed (1895) that repeated doses of alcohol, if gradually increased, cause at 
first an increase in the acidity of gastric secretion in a dog, but this increase was within 
a few days followed by a decrease, not only in the acidity but also in the amount of 
secretion. 



96 THE ALCOHOLIC PROBLEM. 

The fact remains the same whatever the explanation may be. Even 
if it be admitted that alcohol directly stimulates the stomach, which, 
in view of its known depressant action upon all other nerves and 
structures, it is difficult if not impossible to concede, whatever stimu- 
lating effect it may at first have is to be maintained only by increasing 
the dose, and is finally lost altogether, a result which universally 
follows the continual employment of any true poison. This fact 
alone proves alcohol to be not a food but a poison in any and all doses. 

A few months ago I had the pleasure of spending a short time with 
Pawlow in his laboratory in St. Petersburg. Among other interesting 
things I saw there was what has been facetiously called a " canine 
dairy." Pawlow had eight or ten dogs provided with gastric and 
esophageal fistulas. When the dog eats in the ordinary way the food 
drops out through the opening in the esophagus, while at the same 
time a small stream of gastric juice flows out through the opening in 
the stomach. Every morning at 4 o'clock these dogs are brought up 
from their kennels and placed in their harnesses upon a long table 
and are fed for four hours, at the end of which time each dog has pro- 
duced about a liter of gastric juice. The juice is carefully filtered and 
deodorized by passing through charcoal and is shipped to various 
European specialists who make considerable use of it in the treatment 
of specially obstinate cases of gastric disease. Doctor Henecke, who 
has charge of this department of the laboratory, told me that the sale 
of "dog juice' ; is an important source of income from the laboratory, 
the appropriations for which, made by the Russian Government, are 
quite inadequate to meet its requirements. Occasionally a dog 
becomes indisposed and fails to produce the usual amount of juice. 
I suggested to Doctor Henecke whether under such circumstances he 
would think it proper to resort to the use of alcohol. He threw up his 
hands in great surpirse that I would offer such a suggestion, and 
assured me that alcohol was never given to the dogs, and for the 
reason that the activity created by it was not normal and in the end 
results in diminished secretion. This fact has been abundantly con- 
firmed by numerous observers. Last year I repeated an experiment 
upon a dog provided with a Pawlow's pouch in my own laboratory, 
and found at the end of a few weeks a very notable diminution in the 
secretion of hydrochloric acid ; in fact, free HC1 disappeared entirely. 
The dog was a medium-sized animal and the amount of alcohol admin- 
istered was 14 grams daily in the form of brandy diluted with water. 

Pawlow's dogs are cared for with a degree of solicitude far exceeding 
that ordinarily given to human infants. The sanitary condition of the 
rooms in which they live, the ventilation, the temperature — all of 
these matters receive the most careful attention. In relation to food 
and feeding, these animals have the benefit of the most profound and 
up-to-date information which the world possesses. Pawlow unques- 
tionably stands at the head of all physiologists who have ever lived 
in researches pertaining to digestion. 

The majority of human beings are less fortunate than Pawlow's 
dogs as regards the care of their digestive functions. Certainly it is 
our duty as medical men to make available for our patients as rapidly 
as we are able to do so the results of laboratory research which con- 
cern human nutrition, especially as relates to the influence of alcohol 
upon digestion; for the habitual and medicinal use of this drug have 
contributed in no small degree to the prevailing dyspepsia of modern 



THE ALCOHOLIC PKOBLEM. 97 

times. When one considers the enormous volume of alcoholic 
nostrums which are annually poured into human stomachs, in addition 
to the floods of beer and other alcoholic beverages, it becomes a 
matter of wonderment that the condition of the American stomach is 
not even worse than it is. 

The facts which I have above presented I think justify me in 
saying: 

(1) That the habitual effect of alcohol upon the healthy stomach 
is to lessen the ability of the stomach to form healthy gastric juice ; and 

(2) That the use of alcohol even in quantities smaller than that in 
which it is found in beer and light wines, decidedly lessens the activity 
of normal gastric juice. 

In tins connection it must be remembered also that Chittenden as 
well as other investigators have clearly shown that other principles 
in beer and wine have a very decided detrimental influence upon 
gastric digestion. 

Hemmeter and others, who have experimented for the purpose of 
determining the effects of alcohol upon gastric and intestinal motility, 
have shown that motility is either not affected at all or is actually 
decreased under the influence of alcohol. If, then, alcohol is of no 
value as a food or as a gastric stimulant, what useful place can be 
found for it in therapeutics ? Schumacher, in his Materia Medica and 
Therapeutics, sixth edition, 1906, especially recommends alcohol for 
the following maladies: Phthisis pulmonalis, also bone and gland 
tuberculosis, typhoid and other fevers, hypostatic congestion of the 
lungs, pneumonia in aged persons, diphtheria, phlegmonous erysipelas, 
the insomnia and indigestion of old age, the malnutrition of sedentary 
persons, cholera and cholera infantum, snake bite, and gastro- 
intestinal auto-intoxication. 

Let us examine briefly the facts in relation to the influence of 
alcohol in these several maladies. 

ALCOHOL IN TUBERCULAR INFECTION. 

Bell, of New York, demonstrated more than fifty years ago that 
alcohol not only does not cure tuberculosis, but that it actually favors 
its development. Trusseau recognized the validity of Bell's observa- 
tion, and condemned the use of alcohol in tuberculosis. Wright's 
recent experiments have made clear the modus operandi of the per- 
nicious influence of alcohol in this disease, and why persons who are 
habitual users of alcohol are especially susceptible to tubercular infec- 
tion. The observations of Wright have shown that the tuberculo- 
opsonic index is definitely and uniformly lowered by alcohol. My 
colleague, Dr. Charles E. Stewart, in a recent series of experiments 
upon this subject, showed, in collaboration with Drs. A. W. Nelson 
and L. Stoner, of the clinical laboratory of the Battle Creek Sani- 
tarium, that the depression of the opsonic index produced by an ounce 
of alcohol lasts for several hours. In one case the index was reduced 
from 0.93 to 0.21, at which point it was found four hours after taking 
2 ounces of Peruna. In another case 2 ounces of Peruna in four hours 
reduced the opsonic index from 1.30 to 0.07. 

In the face of these facts nothing could be more absurd than the 
administration of alcohol to a patient already suffering from tuber- 
cular infection. The only chance for the recovery of such a patient 

S. Doc. 48, 61-1 7 



98 THE ALCOHOLIC PROBLEM. 

is in the destruction of the invading bacteria by his leucocytes. The 
phagocytosis depends upon the development of the tuberculo- 
opsonin in sufficient quantity to enable the leucocytes to attack with 
vigor the tubercle bacilli. A drug which is capable of lowering the 
tuberculo-opsonic index from 1.30 to 0.07 must certainly exercise a 
most pernicious influence, and in the most pronounced degree encour- 
age the development of the disease. 

ALCOHOL IN TYPHOID FEVER. 

When Doctor Brown, in the early part of the last century, substi- 
tuted alcohol for bleeding in typhoid and other fevers, there was an 
evident improvement in the mortality rate, and this fact led to the 
almost universal adoption of the so-called stimulating plan of treat- 
ment. Milk and brandy every two or three hours was the regulation 
prescription in most of the leading hospitals in Europe and America. 
Thirty years ago the bill for spirits was one of the largest items in the 
expense account of the London hospital boards. About this time 
a hospital was opened in London which undertook the treatment of 
typhoid fever and other maladies without alcohol, and with such 
remarkable success that skepticism respecting the value of alcohol 
as a supporting agent in fever rapidly developed, and at the present 
time the stimulant plan has been almost altogether abandoned in 
all well regulated hospitals, and for it has been substituted the cold 
bath of Brand, the cooling pack of Winternitz, and other rational 
means. 

Chapman more than sixty years ago took a decided stand against 
the then prevailing practice of using alcohol freely in fevers, declar- 
ing that he employed alcohol with as much reserve as bleeding, and 
that he obtained the best results in cases in which it is not employed. 
A fever is a vital battle against invading parasitic organisms. Al- 
cohol lessens vital resistance, hinders the process of immunization, 
weakens the heart, narcotizes the nerve centers, and does not meet 
a single indication which can not better be met by other safe and 
rational means. 

ALCOHOL IN HYPOSTATIC PULMONARY CONGESTION. 

One of the most marked characteristics of alcohol is the vaso- 
motor paresis which it induces. How, then, can it possibly do any 
good in hypostatic congestion? A fomentation to the back, with 
the patient turned upon the side, the elevation of the head and 
shoulders of the patient, derivative applications to the feet and legs, 
or, if necessary, to the whole lower half of the body, are measures 
which produce immediate alleviation, and without any risks or possi- 
bility of harm. Alcohol can do nothing more than produce a tem- 
porary sensation of relief while actually aggravating the condition. 

ALCOHOL IN PNEUMONIA. 

The apparent benefit of alcohol in pneumonia, according to Doctor 
Shoemaker, must be based upon the supposition that alcohol some- 
how increases the energy of the heart; but that this is not true has 
been so often proved by actual experiments, especially by the experi- 
ments of Crile and Hare, that there can be no longer any doubt as to 



THE ALCOHOLIC PROBLEM. 99 

the truth upon this point. Alcohol weakens the heart, lessens the 
resistance, lowers the pneumo-opsonic index, hinders immunization, 
and delays resolution. Derivative applications to the legs, the chest 
pack, and especially an abundant supply of cool, fresh air and abso- 
lute withholding of alcohol, give the aged sufferer from pneumonia 
a fair change for recovery. 

ALCOHOL IN DIPHTHERIA. 

The idea that alcohol is somehow a supporting agent has led to its 
use in diphtheria as well as other infections, but experiments of 
Metchnikoff, Roger, and numerous other competent investigators, 
have shown that alcohol actually increases the susceptibility of the 
organism to bacterial infection, and hence not only prepares the way 
for infection by diphtheria and allied maladies, but encourages and 
intensifies the infectious process when once begun. There is no 
scientific evidence that alcohol ever saved the life of a single child 
suffering from diphtheria. The use of antitoxic serum has undoubt- 
edly saved the lives of thousands by aiding the natural resistant 
forces of the body. Alcohol paralyzes these forces, and hence can do 
nothing but antagonize the normal process of cure. 

ALCOHOL IN ERYSIPELAS. 

The remarks made with reference to diphtheria apply equally well 
to erysipelas and other bacterial infections of the body. Since alco- 
hol lowers the opsonic index and hinders immunization, what else 
can it do but hinder the curative process? 

ALCOHOL IN INSOMNIA. 

Alcohol is a narcotic, and in very moderate doses perhaps produces 
less vital disturbance than most other hypnotics; but its effects 
are extremely uncertain. In most cases the dose must be rapidly 
increased, and its influence in increasing intestinal auto-intoxication 
must hasten the processes upon which premature senility or arterio- 
sclerosis depend, as has been shown by Metchnikoff. The malnu- 
trition of sedentary persons, for which Shoemaker recommends alco- 
hol, should be relieved by removing the cause of the malnutrition 
rather than by the deceptive influence of alcohol. More fresh air, 
care in the selection and mastication of food, the proper adjustment 
of the several food principles, especially the avoidance of a high 
protein ration, and attention to proper intestinal activity, are meas- 
ures which definitely and permanently improve the nutrition of the 
sedentary man, while alcohol produces only a temporary appearance 
of improvement, and often induces a drug habit with most pernicious 
consequences. 

ALCOHOL IN CHOLERA AND CHOLERA INFANTUM. 

Here again we find alcohol recommended under conditions in 
which the body is already overwhelmed by bacterial toxins. If 
recovery occurs, it will only be because the organism is able to destroy 
and eliminate these toxins before they have accumulated to such an 
extent as to produce vital disorganization. What good could be 



100 THE ALCOHOLIC PROBLEM. 

expected from the addition of another bacterial poison to those with 
which the body is already struggling? Alcohol can do no possible 
good in these infectious disorders in which its influence, as in all 
infections, has been shown to be not only to diminish vital resistance 
but to hinder recovery. 

ALCOHOL IN SNAKE BITE. 

While recommending alcohol for snake bite, Shoemaker admits 
that there is little or no scientific evidence of its efficacy. The repu- 
tation of alcohol as a remedy for snake bites doubtless rests on the fact 
that only a comparatively small proportion of those who are bitten 
by snakes are actually poisoned. The virus is absorbed by the cloth- 
ing when the bite occurs upon a covered portion of the body, or the 
virus may be ejected before the fangs are inserted into the tissues. 
It is quite possible, as intimated by Shoemaker, that deadly harm 
has been done by the great doses of alcohol administered in these 
cases. 

ALCOHOL IN CASTRO-INTESTINAL INFECTION. 

Alcohol has been recommended and used in many cases of intesti- 
nal auto-intoxication which resembled in their clinical course malarial 
fever and other specific febrile affections. The impropriety of using 
alcohol in such cases has been clearly demonstrated by Hunt, whose 
experiments showed that the ethereal sulphates, or products of putre- 
faction, are greatly increased in the urine under the influence of 
alcohol. In intestinal auto-intoxication the liver and other poison- 
destroying glands are already overtaxed in their efforts to cope with 
the enormous quantities of toxins with which they are called to deal. 
The addition of alcohol under such conditions can do nothing but 
harm. 

I need not longer tax your patience with the consideration of specific 
maladies for which alcohol is often administered. The list of mala- 
dies in which alcohol has been administered is a long one. It includes 
in fact, almost every malady to which human beings are subject. 

If we should study the whole category we would not find a single 
malady for which alcohol is a specific remedy; and I venture to say 
that we should not find a single one in which alcohol renders service 
which can not be better rendered by some other and more rational 
means. 

My personal experience has fully persuaded me of the absolute 
truth of this statement. I was trained in the practice of medicine 
under the elder Flint. He was a warm advocate of the use of alco- 
hol in pneumonia, typhoid, and other fevers, and especially recom- 
mended its use in' phthisis. In beginning practice more than thirty 
years ago, I was inclined to make occasional use of the drug under 
the supposition that it possessed stimulant properties, but as labora- 
tory research gradually made clear the fact that alcohol possesses no 
stimulant properties whatever except through the transient irrita- 
tion which it produces when brought in contact with living tissues, 
and that its real effect is depressant and paralyzing, I lost faith in its 
curative virtues, and for more than twenty-five years have excluded 
it from my practice; and I can not recall a single instance in which I 
have had reason to believe that its use would have rendered any 



THE ALCOHOLIC PKOBLEM. 101 

service whatever. I have never taken the position that I would 
not make use of alcohol under any conditions, but have held myself 
in readiness to use it in any cases in which I could find a rational 
basis for its application. I am ready to say frankly that in the light 
of my experience and the accumulated evidence of the nature and 
effects of this drug I do not expect to encounter such a case. 

Alcohol should be relegated to the limbo of discarded drugs which 
have been tested and found wanting. The social and moral mischief 
which the drug has done, as well as its physical effects, give sufficient 
reason why it should be accorded drastic treatment, and avoided if 
possible. A decided stand against alcohol on the part of medical 
men, a clear statement of its uselessness as a food and as a medicine, 
and of its pernicious effects upon the animal organism, would arrest 
the attention of the public and advance the cause of temperance 
as no other means could do. 



A PLEA FOR THE ESTABLISHMENT OF HOSPITALS FOR 
THE RATIONAL TREATMENT OF INEBRIATES. 



By Charles A. Rosenwasser, M. D., Newark, N. J., 

Attending physician to the Presbyterian Dispensary, member of adjunct staff of St. James 
Hospital, vice-president of the dependency and crime commission of the State of New 
Jersey. 

In its report to the Hon. John Franklin Fort, governor of New 
Jersey, the dependency and crime commission, appointed by him for 
the purpose of making inquiry as to the causes of dependency and 
criminality and for the suggestion of remedial measures, says : 

We desire to call attention to the importance of the establishment of a hospital for 
persons who are afflicted with the habitual addiction to alcohol and other narcotic 
drugs, so that they may be scientifically treated and restored to usefulness. It is the 
consensus of opinion that our present method of dealing with the inebriate who falls 
into the hands of the law, as he is very apt to do, is barbarous and inhuman, and is a 
relic of the Dark Ages. Punishment for drunkenness has been meted out for centuries, 
and has been proven to be an absolute failure. Why should this method be allowed 
to continue when there is a more rational method of dealing with these unfortunates, 
many of whom, through heredity and environment, are more sinned against than sin- 
ning — a method which in the light of modern progress is as bright and full of hope 
as the present method is full of darkness and despair? The State needs most urgently 
a hospital for inebriates, as a means of preventing insanity, diseased and degenerate 
offspring, and dependency and crime. Aside from its incalculable value as a saver 
of men and women, it would be a great financial gain in the end. 

That this statement is concurred in by practically every person who 
has given any thought to the question you all know. You also know, 
however, that there are a large number of persons who are in absolute 
ignorance of the possibility, practicability, and feasibility of restoring 
the inebriate to a life of usefulness, and that inebriety is one of the 
most curable of chronic diseases, provided that treatment is begun in 
time, is properly conducted, and is persisted in for a sufficient length 
of time. It is plain, therefore, that in order to bring about the 
rational treatment of the inebriate we must with renewed vigor and 
energy continue the campaign of education begun years ago by 
Turner, Rush, Mott, Crothers, Da}^, Parrish, Mason, and others. 

Generally, the public is skeptical as to the possibility of curing the 
alcohol or drug inebriate, and hence we are asked, Can this disease be 
cured ? Is it possible to restore the drunkard and drug user to a life 
of sobriety and usefulness? 

Let us investigate these questions. Let us consider the views of 
some of the world's most prominent students of the subject and 
acquaint ourselves with some interesting facts. 

Dr. T. D. Crothers, of Hartford, Conn., editor of the Journal of 
Inebriety, author of many books and monographs upon the subject, 

102 



THE ALCOHOLIC PROBLEM. 103 

a man who has devoted his entire life to the study and treatment of 
inebriates, says: 

The best authorities unite in considering 35 per cent of all patients remaining under 
treatment one year or more as permanently cured. * * * In view of the chronic 
character of these cases these statistics are encouraging and indicate great possibilities 
for the future from a better knowledge and treatment of these cases. 

Doctor Day, for many years head of the Washingtonian Home, 
Boston, an institution now in the fifty-second year of its existence, 
made a study of 8,000 cases that had been under treatment and 
found over 30 per cent sober and temperate. He says: 

Twenty-two years of experience in this work has taught me that the task is neither 
hopeless nor thankless; nor would it be if the measure of success had been lessened 
one-half from the known rate of percentage of cures. 

Doctor Mason, formerly of the Kings County Home, New York, 
examined the records of 2,000 cases that had been away from the 
asylum for ten years, and found 36 per cent of all cases cured. 

When we consider that in the above-mentioned institutions there 
are encountered the worst cases the percentage of cures is encour- 
agingly high. 

That inebriety can be successfully treated and that a hospital for 
inebriates is a great saving and not an expense to the Commonwealth 
has been demonstrated to the satisfaction of the people of Massachu- 
setts where, at Foxboro, there has been such an institution in suc- 
cessful operation for about eighteen years. From Mr. Robert A. 
Woods, president of the board of trustees, I learn that the average 
number of commitments last year was 127, and a total number of 
480 men were cared for, most of whom were skilled workmen. The 
methods of this hospital include medical treatment in the first stage 
with stimulating industry, gymnasium and baths, proper diet, intel- 
lectual and moral stimulus, and visitation by volunteer visitors after 
discharge. An investigation is made each year as a result of which it 
is known that 30 to 40 per cent of the patients remain temperate for 
at least a long period, and from 15 to 20 per cent more show definite 
improvement. 

Progressive Switzerland has long since learned that inebriety is a 
curable disease and that it pays to maintain a hospital for the pur- 
pose. At Ellikon, near Zurich, there has existed such a hospital for 
the past nineteen years. The result of its labors is most encouraging 
and proves conclusively that the treatment of inebriety has long since 
passed the experimental stage. From its eighteenth annual report we 
learn that — 

Of 531 patients discharged between 1889 and 1901 there were cured 240, or 45.2 
per cent; improved, 126, or 23.7 per cent; relapsed or unheard of, 165, or 31 per cent. 

Of 255 patients discharged between 1901 and 1906 there were cured 144, or 56.4 per 
cent; improved, 61, or 23.9 per cent; relapsed or unheard of, 50, or 19.6 per cent. 

At Knoxville, Iowa, there has been in existence for the past three 
years a state hospital for inebriates, and the results thus far are 
very satisfactory. From the second biennial report of this institu- 
tion we learn that of the entire number of patients treated (774), 41 J 
per cent are known to be cured and living up to the conditions of 
their parole. 

Minnesota has also taken the proper step in this matter, and last 
year established a farm for inebriates. Surely the knowledge of 
the excellent results obtained in the above-mentioned institutions, 



104 THE ALCOHOLIC PKOBLEM. 

as well as the results obtained in the great number of private and 
public institutions for the care and treatment of inebriates in this 
country and abroad, ought to convince the most skeptical, and should 
serve as a great stimulus in our efforts to overcome the obstacles 
which we encounter in the path of rational treatment of the inebriate, 
and there are many obstacles to be overcome. 

Permit me to mention a few of those which I have encountered 
in my efforts to have a hospital for inebriates established by the State 
of New Jersey. 

History repeats itself; and as there were editors of newspapers in 
days gone by who opposed the establishing of hospitals for the 
insane in Massachusetts on the ground that such institutions would 
foster the disease, and would attract patients from other States and 
even from foreign countries, there is to-day an editor of a Newark 
newspaper who opposes the establishment of a hospital for inebriates 
on practically the same grounds. I wonder whether he believes that 
the church fosters sin. 

My prohibitionist friends say that I am starting at the wrong end. 
They say, " Prohibit the sale of alcoholic beverages and there will be 
no more drunkards." How easy to say, and how hard to do. What 
practical man believes that prohibition lessens the consumption of 
alcohol? What practical man doubts that the present so-called 
temperance wave sweeping over this country is aught but a mani- 
festation of hysteria, and that it will soon begin to recede, leaving in 
its wake many a "wet" home which previously was "dry." Prac- 
tical observers know that alcoholic beverages are now to be found in 
homes to which such beverages were strangers before, and there is 
good reason for believing that the percentage of children drinkers 
is growing. Our hope of true temperance lies in education, not in 
legislation. We know that inebriates have existed since the dawn of 
day. Who doubts that they will continue to exist until the crack of 
doom? 

Some, who think themselves Christians, say: Inebriety is the 
result of the sin, and the sinner must and should suffer. Well, if 
this be true, let us close our hospitals and deny relief to every suf- 
ferer from whatever ill, for it may safely be said that almost all disease 
results from some violation of the laws of nature, and to violate the 
law of nature is a sin. This group of objectors is small but ever pres- 
ent. Its members are usually persons who are possessed of a high 
degree of selfishness. They can sometimes be brought to realize the 
importance of the rational treatment of the inebriate on being 
informed that an habitual inebriate is as great, if not a greater menace 
to society than is an insane person, and every bit as much in need of 
restraint for the protection of the community. 

The BingJiamton Asylum failure. — The failure of this, the first 
inebriate asylum to be established in the world, so far as is known, is 
a bugaboo which has been held up before me on several occasions. 
I am glad to have been able to look up the records of the Binghamton 
Asylum, and feel sure that if ever failure was due to success, then 
the failure of this asylum is so to be charged. It appears that this 
institution was a private concern owned by a stock company. It 
certainly made money. There was a stockholders' scramble for the 
funds and for control, and financial failure resulted. But so far as 
the curing of inebriates was concerned, this institution was a decided 



THE ALCOHOLIC PROBLEM. 105 

success, the results of treatment being most encouraging and satis- 
factory. I can not imagine any greater loss to this country than was 
the failure of the Binghamton Asylum. Had it continued to exist, 
it would have served as an example to other States and countries, 
and similar institutions would have been established everywhere, 
and mauy thousands would have been saved from insanity, criminal- 
ity, degeneracy, poverty, suffering, and early death. 

11 Ostrich-like" objectors are also encountered. They prefer to 
hide their heads in the hour of trouble. They fear that the inebriate 
problem is too great to cope with. Needless to say no modern 
student of sociology flees from a problem on account of its vastness. 
He tackles it because he knows that no problem can ever be solved 
in any other way. 

The question of constitutionality has also been raised, and it has 
been asked whether we can deprive a man of his liberty who is not 
insane, and who has not been convicted of crime. Happily this 
question has been decided by the supreme court of Minnesota, which, 
in deciding the case of Leavitt v. City of Morris, says: 

The State, in the exercise of its police power, has the undoubted right to punish 
drunkenness, and to provide for the detention and treatment in hospitals controlled 
by it of those who are habitual drunkards and have so far lost the power of self-control 
that they are either incapable of properly caring for themselves or are a menace to the 
public weal. The State has the power to reclaim submerged lands which are a menace 
to the public health and make them fruitful. Has it not, also, the power to reclaim 
submerged men, overthrown by strong drink, and help them to regain self-control? 
* * * The State has for many years punished drunkenness by a fine or imprison- 
ment. The trend, however, of legislation is to treat habitual drunkenness as a disease 
of mind and body, analogous to insanity, and to put in motion the power of the State, 
as the guardian of all its citizens, to save the inebriate, his family, and society from the 
dire consequences of his pernicious habit. * * * 

The hospital farm for inebriates is not a penal institution, but a paternal one, seek- 
ing not the punishment of the inebriate but the safe-guarding of his interests and the 
safety of the public, by treating the inebriate as, what he is in fact, a man of unsound 
mind, and placing him under the guardianship of the State to the end that he may 
be healed of his infirmity. 

Some say that a hospital for inebriates would merely be a place 
to which a man could go in order to sober up after a drunk. They 
are not aware that in institutions such as we are advocating patients 
can not leave at will, but are committed by law to be detained until 
they are cured or discharged or removed by law. Even though 
such a hospital would occasionally be imposed upon and in some 
way be used as a sobering place, it would be hailed as a blessing by 
many wives and mothers who would be grateful for any relief, how- 
ever small. 

The question of expense is naturally an important one. It con- 
stitutes a real obstacle, as it is apt to frighten the legislators and the 
taxpayers. There is little cause for alarm, however, when we con- 
sider that many patients will gladly pay for their care, that the law 
requires pay from all who can pay, and that the indigents are now 
being taken care of at the expense of the city, county, or State, in the 
general hospitals, jails, penitentiaries, workhouses, almshouses or 
insane asylums; and when we further consider that many of those 
who can be restored to usefulness are fast approaching the day when 
not only they, but their families will have to be provided for by the 
taxpayers, the question of expense assumes a different hue. It is 
therefore clear that the State is not being called upon to bear any new 
burden, but simply to take up a burden which it is now carrying, in a 



106 THE ALCOHOLIC PROBLEM. 

more humane, hopeful, and enlightened manner. Who can estimate 
the ultimate gain to the State when we learn from conscientious stu- 
dents of the subject that at least 33 per cent of insanity, 60 per cent of 
epilepsy and idiocy, and 75 per cent of arrests are due directly or in- 
directly to inebriety. Aside from the financial considerations, it is as 
much the duty of the State to control and scientifically treat the ine- 
briate, as it is to restrain the criminal or madman, for in the preven- 
tion of crime and dependency lies our firmest security. 

It should not be forgotten that hospitals for inebriates are also 
intended to take care of victims of drug habits, every one of whom 
is on the road to the insane asylum, and very many of whom can be 
absolutely cured if treatment is not delayed too long. For the drug 
fiend there is practically no hope unless he is scientifically treated 
under legal restraint in a properly equipped hospital. 

In addition to its value as a saver of men and women a hospital 
for inebriates could also serve as a reformatory for women, for it is a 
well-known fact that almost all fallen women are either alcoholics or 
drug users. It could remove the inebriate tramp from the streets 
and perhaps make him earn his bread by the sweat of his brow. It 
could serve as a center of learning for the medical profession with a 
field fertile with opportunity. 

The people are awakening to the importance of the rational treat- 
ment of the inebriate, but the awakening is rather slow. They are 
busy fighting tuberculosis, and are making a gallant fight. So busily 
are they engaged in fighting the seed which produces the disease that 
they are forgetting that no seed can grow unless it lodges in appropriate 
soil. Alcoholism prepares the soil and renders it fertile, and hence the 
fight against tuberculosis, in order to be successful, must at the same 
time be waged against alcoholism. I can not here enter into a dis- 
cussion of all the measures which have been and are advocated as 
preventives of tuberculosis and of alcoholism, but can say that all 
students of the subject agree that one of the most effective modes of 
warfare is by establishing in every State a hospital for the care and 
treatment of inebriates. There is good reason for believing that ere 
long there will be such a hospital in every State. Pennsylvania has 
already passed a bill to this effect, and the subject is receiving great 
attention in New York, New Jersey, and elsewhere. 

The movement has the support of the New York State Medical 
Society, the Medical Society of New Jersey, the British Medical Asso- 
ciation, numerous prominent judges, lawyers, ministers, and, in fact, 
of all persons engaged in humanitarian work, and by everything that 
is good and uplifting. At present the senate of New York has under 
consideration a bill, introduced by Senator Grattan, which provides 
for the establishment of labor colonies for the detention, reformation, 
and instruction of persons convicted of vagrancy and of habitual 
drunkenness. Under the provisions of this bill only those inebriates 
are accepted who have been arrested for drunkenness and sentenced 
to detention at the colony. There is no provision for the acceptance 
of patients before they have been convicted of drunkenness, not even 
if they desire to voluntarily commit themselves. This is a serious 
error, and one which ought to be speedily corrected. As the bill 
permits the trustees to establish several colonies, it is to be hoped 
that they will see the wisdom of providing a place for those inebriates 



THE ALCOHOLIC PROBLEM. 107 

who are in the early stages of the disease, and for whom there is 
hope, before they provide for those who are in the last stages, and in 
whom the possibility of cure is remote even under the best of care. 
And it is further to be hoped that some provision will be made for 
voluntary commitments, and also to enable a family to place their 
inebriate relative under control without being compelled to have him 
arrested and convicted of drunkenness. The same procedure might 
be followed in such cases as is now being followed in committing the 
insane. Similar provision should also be made for drug inebriates. 

After studying the laws governing hospitals for inebriates in this 
and foreign countries, as well as the laws governing the commitment 
of insane in New Jersey, I drafted a bill for the establishment of a 
state hospital for inebriates and had it introduced during the present 
session of the legislature by the Hon. John F. Clark, member of the 
assembly from Essex County. In spite of the fact that the bill was 
ably championed by Mr. Clark, it met with defeat, but only, I believe, 
on account of the condition of the state finances, which precluded the 
possibility of the State entering upon any new enterprises for the 
present. 

The bill (assembly bill No. 9) provided for commitments as follows: 

A patient may commit himself either by applying directly to the superintendent of 
the institution or to the courts; patients who refuse to commit themselves can, pro- 
vided they are inebriates as defined in the act, be committed on the certificates of 
two physicians in the same manner as the insane are now committed in New Jersey; 
and a committing magistrate may, at his discretion, commit to this institution persons 
convicted of minor offenses if the offense be due to alcohol or drug using. 

In an article entitled "The drink habit and its treatment," which 
I read before the Medical Society of New Jersey, I called attention to 
the fact that the drink habit can be cured in a gratifyingly increasing 
number of cases without requiring the detention of the patient, pro- 
vided that the treatment is begun in the early stages of the disease. 
In view of my convictions, I have provided in the bill that the super- 
intendent of the hospital may, at his discretion, treat without deten- 
tion persons who voluntarily apply for such treatment if, in his 
judgment, they are suitable patients for such treatment. I have 
done this in order to make it possible to reach that large number of 
patients who are. in the early stage of the disease and who will not 
voluntarily place themselves under restraint, and who can not be com- 
mitted by the courts because they have not advanced to the stage 
when they can be included among those persons who are termed 
"inebriates" within the meaning of the act. The bill says: 

The term "inebriate," as used in this act, includes every species of inebriety, and 
extends to every person who is suffering from inebriety, whether caused by the 
periodical or habitual excessive use of intoxicating liquors, morphine, opium, cocaine, 
chloral, or other narcotics, and who, as a result of such excessive use of intoxicating 
liquors or narcotic drugs, has become incapable of controlling himself or his estate, 
or is wasting his estate, or is a menace to the public weal. 

All patients are committed to be detained until they are cured or discharged or 
removed by law, but no person can be detained for a longer period than two years 
without being permitted to leave on parole. 

At the present time there is in New Jersey only one way in which 
an inebriate who is drinking himself to ruin or death and who is a 
menace to himself, to his family, and to society, can be placed under 
legal restraint if he is not convicted of crime or is not insane, and that 
is under the provisions of the habitual-drunkards act. 



108 THE ALCOHOLIC PROBLEM. 

Under this act an habitual drunkard can be committed to an insane 
asylum, but chancery proceedings are required, and the cost is several 
hundred dollars. This act is therefore available only to those pos- 
sessed of worldly goods. To send to an insane asylum an inebriate 
who is not insane is, however, to say the least, a great error, for the 
tottering mind of the inebriate is easily and readily rendered more 
unsound by contact with the insane, and such a man on the border 
line of insanity can soon become insane, a curable patient becoming 
possibly incurable. 

Left to himself the inebriate is practically helpless and hopeless. 
The disease is progressive and gets worse as time goes on. Under 
proper treatment the outlook is as hopeful as it is in almost any other 
chronic disease. Insanity, long thought to be a condition devoid of 
hope, has yielded marvelously to scientific treatment, and we are 
more than justified in the light of modern progress to expect likewise 
marvelous results from the rational treatment of the inebriate. Hence 
this plea. 



THE PSYCHIC TREATMENT OF ALCOHOLIC INTEMPER- 
ANCE BASED ON A PERSONAL EXPERIENCE WITH 1,000 

CASES. 



By John D. Quackenbos, A. M., M. D., 

Member of the London Society for Psychical Research; fellow of the New York Academy of 
Medicine; member of the New York Academy of Sciences; fellow of the New Hampshire 
Medical Society; member of the New York Medical Association; member of the American 
Medical Association; member of the American Associationfor the Advancement of Science. 



I have been requested to discuss before you this evening the treat- 
ment of the drink habit by hypnotic suggestion, and I shall con- 
sider the question with reference especially to the technic, the class 
of cases that are amenable, time limits of treatment with general 
results, and permanency of cure. 

The phenomena of suggestion are explicable on the theory of simul- 
taneous self-manifestation in two distinct worlds of consciousness — -a 
theory now generally accepted by psychologists. These are distin- 
guished as the objective or supraliminal, the world of everyday 
waking life; and the subjective or subliminal, the world of sleep, in 
which the immaterial part of the man employs itself without cor- 
poreal restraint. The subliminal, superior, or better self— the 
pneuma or spirit of the New Testament — is that deathless entity that 
constitutes the true or " inner man" a vast spiritual organism, the 
created copy of God, and as such measurably endowed with divine 
attributes and powers. The objective self is an expression, imperfect 
and partial at its best, of this subliminal through "the flesh/' that is, 
organs of body and faculties of mind. Now the possibilities of a 
psycho-dynamic control of the objective life by this higher self are 
practically boundless, and the whole purpose of hypno-suggestion is 
the establishment of such control, either where it has become relaxed 
or in fields where it has not before been exercised. So long as the 
subpersonal mind quickens sound organs, all defects or irregularities 
in the fulfillment of their functions may be remedied by assumption 
of the natural psycho-physical regulation, and so diseases that are not 
organic are curable by appeal to the subliminal self which orders 
organic life. Still further, all attitudes of the objective mind — its 
trends of thought, opinions, beliefs, desires, propensities, tendencies, 
emotions, and passions — are controllable and alterable by this higher 
human personality, exclusively along lines that are moral and true. 
And suggestion is nothing but a straightforward, heartfelt, forceful 
appeal to this personality, the source of spiritual energy in man's 
being. It is of the nature of creative communication, a calling forth 
into overpowering action of the god part of the man — action that 
carries all before it in the earth life — all tendency to deviation from the 

109 



110 THE ALCOHOLIC PKOBLEM. 

normal type, physical, intellectual, moral — even the objective will 
itself, iron though it seem to be. 

Man, then, in his higher personality, is adequate to the extirpation 
from his objective nature of any abnormal craving or passion, like 
the craze for intoxicants. The latter is singularly responsive to 
treatment by suggestion. In fact, many of the popular drink cures 
are in reality mere suggestion cures, there being no peculiar virtue 
in the drugs administered, as there is no specific for the cure of 
drunkenness. The temporary success occasionally met with is due 
entirely to suggestive action on a susceptible patient anxious for 
relief. The fascination of mystery plays its part in the process, and 
thus the charlatan differs from the regular psychician who operates 
on the psychic centers with the full consent and knowledge of the 
patient. 

The notable increase in the consumption of stimulants, especially 
among the upper classes, estimated at 10 per cent, during the last 
decade in the case of men, and a much larger percentage in that of 
women, is inviting anxious attention to a means of treating the 
victims of alcoholic inebriety, for which so much has been claimed 
in this country and abroad. Upward of one billion dollars are 
spent annually in the United States for intoxicating drinks, and 
another billion for the relief of the destitution, the punishment of 
the crime, and the care of the physical and mental diseases that 
result directly from the drink habit. Especially alarming is the 
growth of the practice among our women. The punch bowl figures 
at all functions, and proud-pied matrons dip freely therein, ten 
drinking to-day where one drank a dozen years ago. School misses 
and college girls are conspicuous among the throng. Such has 
become the vogue; and, worse than this, girls in their teens see no 
impropriety in drinking publicly with men companions. 

Not a few women have lapsed into the drink habit from the use of 
patent medicines containing large percentages of alcohol. Many a 
clergyman can date his downfall from his first dose of Jamaica ginger. 
The step from " disguised boozes" (upon which $75,000,000 are 
annually expended) to whisky, their main constituent, is more than 
easy. 

Even school children are becoming beer and wine drinkers, espe- 
cially those of foreign parentage, and the increasing prevalence of 
this habit is leading to a mental sluggishness, if not defect, among 
the pupils of the public schools that is attracting the attention of 
educators and philanthropists. In few the prevalent wholesale addic- 
tion to the use of alcoholic stimulants — with its accompanying degen- 
erations of kidney, brain, heart, liver, stomach, and arteries; its per- 
nicious influence in the causation of pneumonia and tuberculosis; its 
direct action in diminishing nervous resistance, and so increasing the 
mortality rate in the case of all diseases; the part it plays in the induc- 
tion of insanity, one- third of all mental affections being due to its 
abuse; and its tendency to transmit to offspring not only epilepsy 
and mental defect, but marked degeneracy and criminal propensity — 
is assuming proportions so appalling that it may justly be regarded as 
perhaps the greatest existing menace to the stability of American 
institutions. 

Moreover, the rank and file of the drinking population are swallowing 
a poison far deadlier and more rapid in its action than genuine ethyl 



THE ALCOHOLIC PROBLEM. Ill 

alcohol . This fact is ignored by the temperance reformer, and often by 
the physician. The consumption being greatly in excess of the ability 
of the brewers and distillers to produce wholesome beverages, noto- 
rious adulterations are resorted to. About 50,000,000 barrels of malt 
liquors represent the yearly output of the United States. Much of 
this, to meet the demands of trade, is sold when new and imperfectly 
fermented, and a great deal of sickness is the result. Besides, the 
beer drinker has to run the gantlet of various preservatives, especially 
formalin, with its destructive action on all the organs; of artificial 
bitters like salicin, picric acid, quassia, strychnia, and aloes; even of 
arsenic derived from sulphuric acid made from arsenical pyrites, and 
used in the process of manufacture to convert the starch into glucose. 

Intoxicating liquors are as liable to adulteration; but it must be 
conceded that it is the raw alcohol as well as the admixtures that 
causes the chronic catarrh of the stomach, the Bright' s disease, the 
arterio-sclerosis, the palsies and ataxias, the nervous bankruptcy, 
and the moral degradation of the dram drinker. Good rum as well 
as bad rum will, when used to excess, gradually convert the different 
organs and tissues of the body into specimens of degeneration and 
disease. Bad rum is more prompt in its action, and almost all the 
rum that is retailed is bad, the alcohol being made from corn, roots, 
refuse molasses, and even sawdust converted by acids into a fer- 
mentable sugar. It is the practice of the liquor dealer to stock his 
cellar with casks of crude grain or potato spirit liberally tinctured 
with fusel or grain oil, an irritant poison. He then provides himself 
with a full line of laboratory-made essences — brandy essence (con- 
sisting of oil of grapes, acetic ether, allspice tincture, and alcohol), 
rum essence (composed of butyric ether, acetic ether, vanilla tincture, 
essence of violets, and 90 parts alcohol), gin essence, hot-drop essence, 
whisky essence, etc., and in accordance with the instructions of a 
hand book furnished by the essence manufacturer proceeds to make 
from the same barrel of crude grain spirits, by the addition of the 
prescribed quantity of the several essences, what he advertises over 
his bar as pure liquors. The same barrel gives birth to Bourbon, 
rye, wheat whisky, malt whisky, Scotch and Irish whisky, Jamaica 
and Medford rum, Schiedam-schnapps and Old Tom, cherry, peach, 
apple, blackberry, and Cognac brandy. The cost of the amount of 
essence required to manufacture in this way 120 gallons of Cognac, 
160 gallons of gin, 40 gallons of any kind of rum, and 160 gallons of 
any kind of whisky varies from $3 to $4. 

Such are the cheap artificial imitations of distilled spirits, the 
frightful compounds of fusel oil and whisky essence, the saloon 
keeper palms off with impunity upon the habitues of his cabaret. 
Properly matured ethyl alcohol or unadulterated whisky, itself a 
protoplasmic poison, is hardly obtainable in an American barroom. 
Of every hundred drinks sold in the United States as whisky to-day, 
only one is really whisky; but so clever is the counterfeit that club 
connoisseurs have failed to detect it. Amylic alcohol, or the common 
whisky of trade (and it matters not whether it is dispensed by a 
bishop or a bravo), is the " death's river" setting in resistless current 
toward murder, robbery, misusage of women, paresis, and the 
asylum. Whatever moral, social, or legislative measures may 
eventually be adopted looking to the suppression of the drink habit, 
we are in urgent need of power to restrain in appropriate institutions 



112 THE ALCOHOLIC PROBLEM. 

the habitual drinker of these poisonous spirits, who is, under the 
present conditions, a danger to himself, a curse to his family, and a 
nuisance to the state. 

The following case of a gentleman who drank whisky is represent- 
ative both of the alcoholic disease and its causation, and of the 
method pursued: 

Four years ago Mr. A., who had vainly resorted to the popular 
drink cures, was induced by his friends to make trial of psychic 
treatment. Beginning as a college boy to carouse with his mates, 
engaging in contests to see who could drink the most beer in the 
shortest time, he passed successively through the stages of occasional 
use for convivial reasons, frequent indulgence to brace him for task 
or pastime, periodical paroxysms of alcoholic debauchery, until at 
40 he found himself a continuous drinker impelled by an irresistible 
and insatiable craving, with marked stigmata of degeneration and a 
growing incapacity for professional duty. His wife and daughters, 
for years subjected to constant humiliation at his hands, had come 
to feel the pinch of want, and smarted under the construction placed 
upon his actions by a merciless society. Affection had died in his 
heart, and with it both self-respect and religious sense. In such a 
case at least a year is usually required of forced feeding and restricted 
activity to repair the damaged brain cells and so restore the patient 
to normal efficiency. But within a week the mental attitude may 
be permanently changed and the craving for stimulants obliterated, 
without experience of the nervous exhaustion and unrest that usually 
accompany discontinuance of the habit. Since his first seance (now 
six years ago) Mr. A. has experienced no desire for alcohol. The 
suggestion was given that he would no longer deceive himself with 
the thought that he could safely take one drink and then stop, but 
that it was impossible for him ever to want a drink or ever to take a 
drink for any conceivable reason. He has abstained not through 
conscious effort, but spontaneously, because of an ingrained disin- 
clination to drink, conditioned by subpersonal control. In this 
instance it was further necessary to forbid the use of tobacco, the 
inhalation of which in the form of smoke, by depressing the nerve 
centers and thus creating an imperious demand for its antidote 
(whisky), explains 75 per cent of all the cases of methomania. The 
chain of cause and effect was broken at a blow. The patient neither 
smokes nor drinks; and he has made amends for the suffering he 
inflicted on his family by exalted action meriting their respect and 
love. 

In contrast with the foregoing is the following extreme case of 
chronic poisoning by adulterated liquors excessively indulged in 
between the ages of 16 and 37. 

Every Saturday night W. B. drinks to intoxication, and commits 
other excesses that fill his mind with remorse, so that his condition 
borders on theomania. He imagines the people riding on the car 
with him know all that he has done, and that the children on the street 
are cognizant of his misdoings and are calling him names significant 
thereof. He is afraid of everything. He suffers from hallucinations 
of vision. A woman with a baby carriage is forever following him. 
He sees green flashes in the dark and men going through various 
motions. Flies attend him everywhere, hovering about, showing 
him how to use his tools, etc. He does not know the difference 



THE ALCOHOLIC PROBLEM. 113 

between a real and an imaginary fly, and continually shoos the latter 
variety. Three separate voices talk to him, coming up the dumb- 
waiter shaft or speaking througn the window. They never desist, 
even while he is at work, and at times seem so real that he looks 
around to see who is speaking. One voice will keep repeating some 
message, laying stress principally on his sins. If he is reading a 
paper, it reads ahead of him. Three years ago his mind gave way, 
and be took a natiron and went upstairs to kill a man who was 
calling him vile names, the man being perfectly innocent. He rallied 
from this seizure, but returning to his fusel oil he has become subject 
to melancholy spells and to attacks of amnesia, so that he loses his 
sense of identity for days at a time. 

This is not a common case of " three sheets in the wind," but rather 
of a noble brought to ninepence through incurable degeneration of 
the brain. There is no hope for such a victim in mental thereology. 

By means of the enlightened employment of hypno-suggestion the 
subliminal self of the ordinary inebriate may be placed in control. 
So it is no longer a valid argument for a man to hold that he gets 
drunk because he can not help it. Statistics show that the treatment 
of alcoholic subjects by suggestion (in this country and abroad) gives 
at least 75 per cent of radical cures. All other known methods have 
never given more than 30 per cent. 

Dipsomaniacs, as a rule, are easy subjects, in that they yield readily 
to the hypnotic influence and accept unconditionally the suggestions 
communicated by the operator. Regular drinkers may be dealt with 
whenever they can be induced to sober. Periodic drinkers should be 
treated just before the close of the cycle of sobriety. Regularly recur- 
ring debauches have periods of varying length, the longest in my expe- 
rience being three years; and I have satisfied myself that in many 
instances a relationship exists between the abuse of tobacco and the 
oncoming of the irresistible thirst, the depressing effects of the nico- 
tine instinctively suggesting recourse to the antidote. Periodic drink 
storms are usually forecast by significant indications well known to 
the family and friends of the victim — irritability of temper, unrea- 
sonable suspicion, so-described " cranky spells/' abnormal restlessness, 
unaccountable depression. Immediately upon the appearance of 
these symptoms the patient should be treated by suggestion before 
opportunity is given for indulgence of the craving. Such a subject 
frequently recognizes his danger and sincerely wishes to be cured. He 
is tactfully conducted into the subliminal sphere, and then assured 
that, in accordance with his own desire and decree, he has lost. all 
craving for beer, wine, whisky; that alcohol in any form is repugnant 
to him, and as a safeguard that he can not swallow it, can not carry 
the containing glass to his lips. The society of low companions 
is tabooed; the pleasures associated with drink and the glamour of 
the barroom are pictured as meretricious and placed in vivid antith- 
esis to the chaste delights of home life. The physical, mental, moral, 
and economic bankruptcy that accompanies dipsomania is held up 
before the view of the sleeper, and he is forced to the conviction that 
begotten of this apprehension has come into his soul an abhorrence for 
drink and all that it stands for. He realizes the presence of efficiency 
within him adequate to the enforcement of radical abstinence as the 
principle of his life ; and he is rendered insensible for the future to any 

S. Doc. 48, 61-1 8 



114 THE ALCOHOLIC PROBLEM. 

such combination of passion and allurement as has usually constituted 
temptation. So he is led instantaneously to scorn recourse" to alco- 
holic stimulants, or to extrinsic exaiiation of any kind, either for con- 
vivial reasons or in time of depression, misfortune, or sorrow, and to 
depend exclusively, under any mental or physical strain, on the units 
of energy legitimately manufactured out of nutritious food, nonintoxi- 
cating drinks, air, exercise, and sleep. The subpersonal mind is then 
directed to the vocation or the avocations, or both, as circumstances 
suggest, and a career of wholesome activities and satisfactory success 
is imaged as the legitimate result of the abandonment of the compro- 
mising habit. 

Hypno-suggestion here is clearly of the nature of inspiration. It 
is a summoning into control of the true man. For the patient freely 
expresses his best self post-hypnotically, without effort, from a plane 
above that of the will — the plane of apprehension and spontaneous 
command along lines of thought and action that are worthy and 
wholesome. And inspiration, to be efficacious, can not be mere lip 
work or rote lesson. It implies a belief in the suggestions offered, an 
eloquent and incisive manner born of the courage of conviction; in 
short, it is a transfusion of personality. Perfunctory speeches are 
of no avail, for the mind of the subject is endowed with supranormal 
insight, at once detects the disingenuous, and declines impulsion at 
the hands of an insincere or lukewarm operator. 

A sine qua non of success is the consent of the patient, an honest 
desire on his part to reform. Habitual drinkers, those who "soak," 
as Goldsmith described it, do not, as a rule, wish to be cured. They 
enjoy indulgence in alcoholic beverages and the false pleasures that 
attend it; and about 90 per cent of them, women as well as men, 
resent the approaches of those who desire to save them. Sometimes, 
when no other form of appeal is effective, they may be frightened 
into a realization of the fact that constant use of alcoholic stimulants 
will result in organic changes in the liver, kidneys, and brain, or by 
lowering the general powers of resistance and at the same time 
irritating the bronchial tubes and the lungs, through which the 
alcohol is in part eliminated, markedly predisposes to pneumonia 
and tubercular consumption. In fact, immoderate drinkers may, 
in sober intervals, be made to realize, not only that they are phys- 
ically depraved, but intellectually degenerated as to the faculties 
of memory, attention, concentration, judgment, and that they are 
deficient in business tact and in the general address essential to suc- 
cess. Once apprised of their enervated mental condition, they are 
overcome with remorse and honestly desire to correct the habit. 
Under these circumstances it is comparatively easy to persuade a 
patient to accept treatment, and a rescue may be effected in a week's 
time. To quote a Hindoo proverb, ' 'In the awful silence that follows 
the storm, not in the silence before it, we should search for the budding 
flower." 

No reference is here intended to dipsomania as a true circular in- 
sanity, characterized by irresistibly compelling paroxysms of thirst 
and accompanied with uncontrollable nervous and mental excitement. 
It has been truthfully said that a sufferer from this disease is insane 
before he begins to drink, and would continue to be insane during this 
period if whisky were unobtainable. Thus there may be dipsomani- 
acs who have never tasted alcohol. The alcohol is a secondary factor. 



THE ALCOHOLIC PEOBLEM. 115 

In other words, a man may drink because he is crazy, or be crazy 
because he drinks, or both; and a physician who grapples with the 
combination has a veritable wolf by the ears. 

It is not claimed that the tendency to relapse is absolutely obliter- 
ated by suggestion. The cure may or may not be permanent, as is 
the case with rheumatism, quinsy, bronchitis, intermittent fever, with 
its distinct germ, and distinct specific. No physician is asked to guar- 
antee a patient against a recurrence of tonsilitis, especially when the 
patient deliberately exposes himself to the appropriate conditions for a 
relapse. More can not be expected of the physician suggestionist, who 
is not a miracle monger. The utmost he can do in a prophylactic line 
is to reject all compromises in his treatment, suggest total abstinence, 
forbid exposure to temptation, and render insensible to the psychology 
of the saloon. Experience proves that it is always better to deal in 
drink-habit cases with the nearest of kin rather than directly with the 
patient, who naturally overestimates his power of resistance and is 
singularly impatient of restraint. Courting a conflict with the demon 
of drink, as many do, is playing with fire. 

Various reasons are advanced by backsliders to explain their re- 
lapses, and some of them are most trivial, as the death of a favorite 
dog, dull times, inharmony in the family. Some drink when they 
feel best, others when they feel worst, some others because they deem 
it a satisfaction to "go off on a tear and tank up." One man used 
the argument that he had gone sober so long he was justified in a 
debauch. A lady admitted her motive to be the delight she experi- 
enced in drinking with her admirers and listening to their flattery 
and compliments. Another lady, with a much greater show of 
reason, explained her periodicals as due to the cumulative brain fag 
resulting from a miscellany of little worries. Here, as in many 
similar cases, alcohol serves to obscure fatigue or cell exhaustion, 
which, if so treated, must end in neurasthenia or irreparable brain 
damage. 

Many drink to dispel the blues, to induce sleep, to rouse courage 
or confidence. 

A very intelligent inventor offered four reasons for indulgence, viz, 
requirement of the system in consequence of physical depression, 
sociability, business necessity, and cold blood or "pure cussedness." 
Sometimes the drinker has no object in view, but seems to be actu- 
ated by a sense of obligation to a long-standing habit, periodical 
conformity to which is fraught with discomfort and misery. The 
psychology of this latter mental state is illustrated by the following 
experience of a friend, who, a summer or two ago, met a farmer ac- 
quaintance on the public highway, trudging along to a near-by vil- 
lage. "Where are you bound for, Uncle Billy?" he inquired, in a 
spirit of neighborly bonhomie. "I am going into Johnstown," was 
the reply, "to get drunk, and O Lord! how I dread it!" 

I have already stated that 75 per cent of inebriates are abusers of 
tobacco, and that in this latter abuse is to be found the proximate 
cause of much alcoholic intemperance. The real danger to the 
smoker consists in the habit of inhalation, whereby the volatilized 

Eoisons of tobacco are brought into immediate contact with many 
undred square feet of vascular air-sac walls in the lungs, and are 
thus promptly and fully absorbed, to be diffused into the blood and 
carried on their fatal errand to the several organs of the body. Young 



116 THE ALCOHOLIC PROBLEM. 

subjects immediately learn to inhale. They are, moreover, mark- 
edly susceptible to the influence of tobacco poisons. Gravest of all 
the resulting evils is the lessening or complete loss of moral sensibil- 
ity, with a conspicuous tendency to falsehood and theft. The moral 
propensities are eventually destroyed because of the destruction of 
those elements of the brain cells through which moral force is 
expressed. The victim degenerates into an unmanly, unprincipled, 
irresponsible doddy-poll, in splendid fettle for the penitentiary or the 
madhouse. 

The circulation through the brain of tobacco smoke poisons and 
alcohol destroys the capacity for expressing through that brain 
earnestness and sincerity in efforts to reform. Fortunately the dam- 
age done to the cells is reparable by the discontinuance of the toxins 
and the judicious administration of nourishment, general and specific. 
While hypnotic suggestion may regulate a disturbed metabolism in 
the nerve organs or check atrophic changes in cell protoplasm, it 
can not be expected to repair lesions in the blood-vessel sheaths or 
suddenly atone for the results of an exaggerated destructive meta- 
morphosis in the nerve-cell bodies. Therefore, in my treatment 
alcohol is immediately withdrawn, stimulating liquid food is given 
every two hours for a day or two, and the phosphor-glycerates, 
representing true brain aliment, are administered for six months to 
a year, with a view to refining the quality and increasing the quan- 
tity of the lecithin through which resolution and general manliness 
are expressed. In the insanity of extravagant drinking, coupled 
with chronic nicotine poisoning, suggestive treatment may sometimes 
be delayed with advantage until after the compulsory reduction or 
withdrawal of the artificial stimulant. Patients who, to rid them- 
selves temporarily of the importunity of relatives, accept an institu- 
tional life, with mental reservation as to their habits at the termina- 
tion of the period of treatment, are proper subjects for suggestion 
while in sanatorio. "The tongue has taken the oath, but the mind 
is unsworn. " Under such circumstances, with the craving in lull 
the subliminal self may be successfully impressed. 

The success of the treatment outlined above bears a distinct rela- 
tion to the amount of injury already inflicted upon the brain cells 
and the accompanying mental deterioration. Its advantage consists 
in the rapidity of restoration to self-control without the necessity for 
effort of will, without the physical discomfort or suffering that usually 
attends abandonment of the habit, and most conspicuously without 
the breaking of family ties and the enforced absence from professional 
or business duties that are implied in sanatorium treatment. 

The views here advanced are based upon an experience with some 
thousand cases of alcoholic intemperance extending over a period of 
ten years. Of these, between 80 and 90 per cent have been perma- 
nently cured. Of the remaining 15 per cent a number can not be 
traced; a number indifferently submitted to one or two treatments 
out of deference to the entreaties of friends, and hence there was no 
objective self -surrender ; a few had become paretic before the treat- 
ment was begun; a small fraction were society women, who, in my 
experience, are almost without the pale of hope. In no other condi- 
tion that I have been called upon to treat by suggestion am I so unre- 
servedly warranted in saying to the sufferer, "If you sincerely desire 
to be cured of this malady and will carry out my instructions faith- 
fully for a year, you can be cured beyond a perad venture." 



HYDROTHERAPY AND ELECTRICITY IN THE TREATMENT 

OF ALCOHOLISM. 



By Dr. J. C. Walton, 

Proprietor of the Hydro- Electro- Therapeutic Sanatorium, Richmond, Va. 



We all painfully realize the evils of alcoholism and extend our 
sympathies to the unfortunate victim and his dependents, but help 
as well as sympathy is what the situation demands. 

Modern medicine made a great advance when it recognized alco- 
holism as a phase of disease instead of as, formerly, regarding the 
alcoholic as a malefactor and as one who could reform if he would 
but make an earnest effort. Now it rightly regards him as one suffering 
from a diseased condition which has incapacitated him mentally 
and physically, whose system is poisoned by overindulgence, non- 
elimination, and who in addition to all this may be the victim of 
heredity and environment. 

It necessarily follows, therefore, that the first step in the manage- 
ment of the alcoholic is to ascertain what is wrong, to correct the 
same, make a careful physical examination and try to discover the 
underlying causes, physical and mental, and if possible to remove 
them, convince him that you are his friend and are anxious to help 
him in every possible way. 

Place him in a quiet, well-ventilated room, with a trustworthy 
attendant who will see that your instructions are faithfully carried 
out; remove stimulants as rapidly as safety will permit, as his tissues 
are already poisoned and saturated with alcohol, and eliminate the 
poison as rapidly as circumstances and the condition of your patient 
will allow; see that he is made comfortable and gets plenty of sleep, 
even if you have to resort to sedatives to produce sleep. As a general 
rule a hypo of morphia and atropine fulfills this indication better 
than any other hypnotic. At the same time give a brisk mercurial 
purge so as to thoroughly empty the prima vise, this to be followed 
by tonic doses of infusion cinchona — 2 ounces every few hours. 

A daily Baruch bath for its eliminant, tonic, alternative, and refresh- 
ing effects upon the entire organism, with the electric-light bath 
followed by douches. The writer's experience agrees with Crothers 
as to the results of the electric-light bath and finds it one of our most 
trustworthy agents for the relief of the distressing symptoms of 
drug and alcoholic addiction, the elimination of both solids and 
water is largely in excess of that from the heat or steam bath, the 
depression much less with a marked calmative action greatly relieving 
the thirst, insomnia, and nervous depression. The sygmographic 
tracing also shows a reduction of 10 to 20 millimeters. The patients 

117 



118 THE ALCOHOLIC PROBLEM. 

are more easily brought under the influence of drugs, much smaller 
doses acting better than larger sizes of the same drug before the bath. 
When we reflect that the electric-light bath contains chemical as 
well as heat rays, we are not surprised at the results. 

Static electricity with hydrotherapy make an ideal combination 
and fulfills every indication. It should be used once or twice daily — 
the morton wave current from a 16 to 20 plate static machine, twenty- 
minute seances — with as long a spark gap as the patient can com- 
fortably stand, enough to produce good and strong vibrations. It is 
best applied by means of a flexible metallic electrode 3J inches wide 
and long enough to cover the entire spine from the occiput to the 
coccyx. 

This treatment gives the most striking and remarkable results, and 
after the first treatment the patient clamors for more, the effects being 
decidedly tonic and sedative, relieving nervousness, producing sleep, 
and a general feeling of well-being and comfort, and thereby rapidly 
restoring to a normal condition. 

Time and an extensive experience have convinced the writer that the 
treatment briefly above outlined is sensible and rational and that it 
comes nearer meeting the indications and overcoming the various 
morbid conditions encountered among the alcoholics than any other 
methods of treatment. I will report a typical case in closing. 

Mr. A., age 50, head of a large corporation, was admitted to the 
sanitarium last January; had been drinking heavily for the past few 
years, and had taken the Oppenheimer and many other so-called 
cures; general condition bad, and he was a picture of abject misery. 
Enlargement of right lobe of liver, nausea, insomnia, and could not 
write his name on account of muscular tremors; was ordered Baruch 
baths with the electric-light baths and static electricity. Improve- 
ment prompt and decided; left the sanitarium after a week's stay 
and returned to his business, signing over 100 checks on the sixth 
day of treatment. His wife called at the office on the eighth day to 
thank me for this wonderful transformation and to assure me of her 
appreciation and gratitude, and this was really the most satisfactory 
part of my fee. 

This short treatment started this man well on the road to recovery. 
We all are well aware that a case of this kind requires prolonged care 
aud treatment, with constant supervision for weeks or months in 
order to make the cure a permanent one. 

Patient, after leaving sanitarium, continued treatment by taking 
Baruch baths and static electricity on alternate days, and still holds 
out faithfully three months after leaving sanitarium although his 
business necessitates the strenuous life. 

In those cases of alcoholism complicated with chronic nephritis and 
an arteriosclerotic condition of the blood vessels, the Darsonal or 
high frequency currents administered once daily, twenty-minute 
seances, the patient lying on an autocondensation couch, connected 
with the Darsonal apparatus, which is excited by a large static 
machine, 16 or 20 plates, running at high speed. This treatment 
gives the most happy results, increasing the urinary secretion, both 
solids and water, and raising the specific gravity, lowering arterial 
tension, improving the general condition in ever}^ way, and, all in all, 
will come nearer restoring a normal condition than any other pro- 
cedure with which I am acquainted. 



PAPERS RELATING TO THE ALCOHOLIC PROBLEM 

IN ITS SOCIOLOGICAL, PHYSIOLOGICAL, AND 

MEDICAL ASPECTS. 



119 



THE ALCOHOLIC PROBLEM IN EVERYDAY LIFE. 



By Howard A. Kelly, M. D., 
Professor diseases oj women of the Johns Hopkins Hospital, Baltimore, Md. 



1 take it as my privilege, speaking on this first day of the session, 
to avoid entering into any of the minuter scientific discussions which 
will naturally follow in our programme, and to address myself some- 
what generally to trie topic, hoping that I shall be able to voice the 
mind and give expression to the sentiments of the thoughtful medical 
profession of the country. I take up therefore the question of 
alcohol as it has gradually crystallized itself in my mind as a result 
of unnumbered experiences — experiences, which, though rightly 
counting for the validity of a positive judgment, have not been filed 
away in any available written records. It is true that in this way, 
too, prejudice may be fed, but I feel sure the best judgment the 
world has to bring to bear upon its problems, affecting our deepest 
and most sacred interests, are constantly formed by this less laborious 
process. 

I feel unwilling to take up my subject, brief as it is, without first 
voicing the sentiment of this assembly and of tens of thousands of 
others who are not here, in expressing my thankfulness for the recent 
articles which have appeared in the press since last fall, notably in 
McClure's Magazine. These articles seem to me to include all we need 
for campaign purposes; they are scientific, authoritative, brief, 
pointed, available to everybody, and convincing. One of my friends 
who instructs the boys in the high school in Brooklyn, N. Y., tells me 
she uses Dr. Henry Smith Williams's articles (in numbers for October, 
December, 1908, and February, 1909) in place of a text-book. If 
the liquor interest of the country with its fabulous wealth has nothing 
to say in rebuttal to these damning public accusations, we may well 
conclude the case is settled as far as good logic and convincing argu- 
ments can settle anything. I would also especially mention with a 
sense of thankfulness the articles of the Rev. Charles F. Aked and of 
the two Rosanoffs. Doctor Aked is, to my mind, a sturdier champion 
of temperance than he is of Christianity. We all feel thankful, too, 
do we not, for the confessions of the New York saloon keeper, which 
throw a lurid light on the abominations which corrupt this business — 
root, stem, and branch — through production, distribution, and con- 
sumption. 

Professor Miinsterberg, too, has helped us by demonstrating the 
feebleness of the position of the moderate drinker whose cause he 
champions. He renders also a real service by showing the diffi- 
culties in the way of making prohibition effective; let us not minim- 
ize them. At such a time as this, in the flush of success, we may 

121 



122 THE ALCOHOLIC PROBLEM. 

well ask whether it will not be wiser to pay closer attention to the 
objectors. 

He asks these pertinent questions, which we dare not brush lightly 
aside: Does prohibition really prohibit? Are we ready for prohibi- 
tion? 

If we adopt prohibition before the whole public is ready for it, will 
we put a premium on lying and tempt our people to evade and 
despise the laws of the land ? 

I am thankful for Professor Munsterberg's article, as it is the 
strongest presentation on the side of the defense. 

In this brief tribute I would not omit to thank also the Ladies' 
Home Journal for its letter from President Eliot, of Harvard College, 
and for the opening paragraph of a paper by Professor Miinsterberg, 
in other respects a disappointing production. 

The cause of good morals in this land would be greatly aided if the 
daily press were equally courageous and aggressive. To what daily 
paper can I look for an invariably candid, strong expression of opinion 
touching every great moral issue ? One or two great New York papers 
would come near meeting this want were it not for the frequent out- 
cropping of bitterness and bias. 

With regard to my own work, I speak (1) as a physician with 
thirty- two years' experience, dating from the beginning of my 
medical studies, and (2) as a citizen deeply interested in public 
affairs. 

I began my practice in private life by prescribing alcohol in its 
various forms as an easily diffusible stimulant in cases of periodic 
weakness, in low fevers, and exhaustion, in accordance with the 
common custom of a generation ago. The physiologic argument 
was a simple and a short one. The patient is weak; she needs 
strength." What drug have we which will at once give the desired 
strength? Answer, alcohol. 

Alcohol whips up flagging energy and produces an appearance of a 
temporary improvement; therefore give alcohol as a tonic at inter- 
vals until the patient is able to do without it. This was much like 
the fallacious argument which appeals so often to the relatives of a 
patient: "When Mary was well and robust, she had a good appetite; 
now she is sick and she has no appetite. Doctor, please give her a 
prescription to give her an appetite, and we know she will be well 
again." 

My medical experience has taught me that the effect is temporary, 
evanescent ; that the drug (for such it is) does no real good, and that 
a dangerous habit is thus easily engendered which may be most diffi- 
cult to eradicate, a habit which may utterly ruin the patient — body, 
soul, and spirit, making it far better if she had died at once of her 
disease while under the doctor's care. 

It is clear in the light of experience and of recent research work 
that alcohol ought to be classed in the list of dangerous drugs along 
with morphine, cocaine, and chloral, a drug which may so affect the 
will power as to gain the complete mastery over a patient, and in 
the end destroy him. 

English and German physiologists have since that period, twenty- 
five years ago, demonstrated beyond a question that the continued 
use of alcohol in any quantity is not only useless, but positively harm- 
ful, and on the basis of experience I appeal to my colleagues every- 
where to abjure its use. 



THE ALCOHOLIC PROBLEM. 123 

The fittest uses a doctor can make of alcohol are to preserve dead 
tissues, cancers and the like, and to dehydrate sections of tissue for 
the microscope. 

Those who drink constantly in so-called "moderation" often 
develop alarming symptoms, in time associated with diseases of a 
degenerative character affecting in the lines of least resistance one 
or other of the great vital organs of the body. In operations these 
factors demand careful consideration. In the prognosis they are 
as a rule more important than any other factor; a habit of "moderate " 
or excessive drinking lowers the vitality and lessens the reparative 
powers, so that serious postoperative complications are likely to 
follow and interrupt or even cut short the convalescence in such cases. 

One of the most alarming effects is that observed in the arterial 
walls and in the heart muscle, which are weakened. The impairment 
of nutritive processes is another pronounced factor. All rational 
surgery and treatment of disease takes into serious account the 
question of the use of alcohol by the patient. This is science and 
not sentiment or theory. 

As a citizen, with eyes opened perhaps a little wider because of my 
medical training, I observe that alcohol has destroyed the happiness 
and the lives of relatives, friends, and acquaintances; that it has 
sometimes served to degrade the noble-minded and the godly man 
below the level of the pig. 

I have seen that it robs the home of peace; it puts a barrier between 
husband and wife and kills all true parental tenderness, throwing the 
children back into the world for that moral training a father and a 
mother are alone fitted by nature to give. 

As a citizen, I observe with alarm an increasing tendency to its use 
by women in society, who take cocktails, champagne, and the various 
wines of the table. I have seen sweet, modest girls, flushed with wine, 
become loud and boisterous, and, with habitual indulgence, coarse, 
and at last ruined morally and physically. I have never met a man 
or a woman who indulged freely who loved the truth or had any clear 
vision of the value of spiritual things. Its use is perhaps the com- 
monest cause of spiritual blindness. 

As a citizen I further note that it is one of the most dreadful and 
insidious of all corrupting agents known to men in debauching 
legislatures and robbing our citizens of the results of their labors at 
the ballot box, making a government of the people, by the people, 
for the people a farcical phrase, while king alcohol sits enthroned 
in the legislative hall. 

As a citizen I note that it is alcohol which fills our prisons, whether 
taken in the form of a stronger beverage as whisky or beer as a 
representative of the milder beverages. 

It is at the bottom of most crime — domestic infelicity, poverty, 
seductions, murders; it is allied to all that is evil and destructive of 
the high aims of civilization. 

One of the greatest lessons life has taught me is that great truths 
grow not stale but sweeter with repetition, so I do not hesitate to 
remind you of certain things, though you know them. I therefore 
pause a moment-as I approach my conclusion to consider some of the 
common arguments against total abstinence urged by a friend of 
mine a few days since as we discussed this momentous topic. First 
and foremost stands that time-honored assertion so often heard on 
the lips of the drunkard as well as of the moderate drinker: "It is a 



124 THE ALCOHOLIC PROBLEM. 

sign of weakness to pledge myself to abstinence. My will is strong 
enough; I can control myself; I can quit when I will." It seems 
to me, I replied to my interlocutor, that the best answers to argu- 
ments in the realm of morals are the facts, and here they are undis- 
puted : Out of all the drunkards and the tens of thousands of criminals 
made what they are by alcoholic liquors, of the thousands who fill 
our insane asylums and the tens of thousands of dependents in our 
poorhouses, it would be hard to find one not equally assertive of the 
sovereignty of his will in all his acts and of his entire ability to take 
liquor or to let it alone, as he might choose, when he started out. 

It is pitiful to hear now and then even a poor, debauched drunkard, 
with one foot slipping over the edge of the grave, still reiterating this 
same old worn-out phrase. I think I still hear the last feeble refrain 
as he topples into the grave, "I can — " but all who pitifully watch 
him know that he can't. What a peculiarly damnable trait it is in 
alcohol, that while it is literally destroying the highest centers in the 
brain and wiping out the fibrils of association so necessary to the 
will in forming a judgment to act or to restrain it yet deludes its 
victim into thinking that he has quickened powers, a stronger will, 
and a better judgment. Those are interesting experiments cited 
by the RosanofTs and adverted to by President Eliot of Harvard 
in his paragraphs in the Ladies' Home Journal (March, 1909), where 
the typesetters were tested with t}?-pe-written copy under moderate 
drinking and after abstinence, when it was found that while they often 
thought they were doing more work under the influence of the drug 
in reality they were doing far less. It is evident from these experi- 
ments that a liquor-imbibing nation assumes a heavy handicap in the 
race for industrial supremacy. 

I hear the makers of alcohol, at last roused by the prohibition wave, 
crying out that they stand for its moderate, not for its immoderate, use. 

In reply to this I answer that if they make it and sell it the use 
is practically beyond their control, and that their plausible declara- 
tions are as light as the paper on which they are written, and can in 
no way affect its use, whether moderate or immoderate. I further 
inquire why these gentlemen have been so long in reaching this 
benevolent conclusion. I declare that I believe their contention 
and their expressed desires are specious and false, and, further, I aver 
that, judging by such scientific evidence as we now have, there is no 
such thing as a moderate use of alcohol. 

•If it is "a sign of weakness to be a total abstainer," I hasten to 
confess my weakness, and I confess it for all who are dependent upon 
me; would that I might also make confession for the whole world. 
We are no stronger than many of the thousands of bright young men 
and fine women who thought they were strong and found out their 
weakness only too late. 

"It conduces to conviviality." So it does, but of what kind? 
We have a word in our language which describes this conviviality 
in all its phases, from the sparkling eye and the loosened tongue 
and the ready repartee, all the way up the gamut to the dull, stam- 
mering speech and the disgusting caresses, perfumed with exhala- 
tions of stale liquor, and that word is " maudlin." 

Under all circumstances when a man talks to me and I lend him 
my interested attention I want to know that he means what he 



THE ALCOHOLIC PKOBLEM. 125 

says. Alcoholic talk robs speech of all moral force. God grant 
that no alcoholic conviviality may ever enliven the board at which 
I sit with friends or family. 

"To condemn alcohol by not taking it in company makes one 
appear a faddist." Well, that may be said of everyone who opposes 
sin in any of its forms. It is hard to go against common practice, 
but it is one of the hard things that puts moral fiber into one, and 
that's the best thing we have in life. 

Some recent clippings may well serve to show the attitude of lead- 
ing minds of the race toward this great question. 

Professor Munsterberg says of the saloon in the Ladies' Home 
Journal (March, 1909) : 

There is nothing more degrading and no more atrocious insult to civilized life than 
the American saloon. It has poisoned the social atmosphere for the masses; in it 
the workingman squanders his savings, and the healthy man devastates his energies 
and becomes a wreck. Political corruption irradiates from the saloon into the whole 
public life, and a thousand ways lead from the saloon into the penitentiary. It is a 
blessed movement which now turns with overwhelming energy against the horrors of 
this evil and unites the clean minds of the whole nation in an untiring fight against 
this source of infection. There may be disagreements as to the best ways and means, 
disagreement whether strict prohibition or education toward temperance is the more 
reliable method ; but there is no disagreement as to the fact that the saloon has to be 
wiped out, and the day seems near indeed when — thanks to women — the fight against 
the saloon will be taken up in almost every State. 

Huxley was once asked what he thought of alcohol as a stimulant to the brain in 
mental work. His reply was prompt, unequivocal, decisive: "I would just as soon 
take a dose of arsenic as I would of alcohol under such circumstances. Indeed, on 
the whole, I should think arsenic the safer, less likely to lead to physical and moral 
degredation. It would be better to die outright than to be alcoholized before death. 
If a man can not do brain work without stimulants of any kind he had better turn 
to hand work — it is an indication on Nature's part that she did not intend him to be 
a head worker. The circumstances of my life have led me to experience all sorts of 
conditions in regard to alcohol, but on no conceivable consideration would I use 
alcohol to whip up a tired or sluggish brain." 

Cardinal Manning said for the Roman Catholic Church: 

I impeach the liquor traffic of high crimes and misdemeanors. It is mere mockery 
to ask us to put down drunkenness by moral and religious means alone. 

I often wish this great church, with her unexampled control over 
great masses of our citizens, would speak out more in public about 
this and all the mighty moral issues which are stirring us to-day. 

We sadly want authoritative utterances from this source from the 
hierarchy. 

The public opinion of the day is thus well set forth in the New York 
Tribune : 

Upon what does the liquor traffic depend? Upon debased manhood, wronged 
womanhood, and defrauded childhood. It holds a mortgage over every cradle, a 
deed written in the heart's blood over every human life. 

My associate, Doctor Burnam, but a few days ago returning from 
Kentucky, sitting in the Pullman car with a number of traveling 
salesmen, was deeply interested on noting the changed attitude of 
this observant class of men toward this great problem. In the first 
place they themselves had no thought of drinking, while they were 
eagerly engaged in discussing the effects of the recent change in the 
laws of the State of Ohio, and the prospective changes of a still more 
drastic nature, to do away not only with the sale but with the manu- 
facture of alcoholic beverages as well. These gentlemen stated that 



126 THE ALCOHOLIC PROBLEM. 

in their own personal experiences, representing a diversity of inter- 
ests, they had noted the greatest improvement in the tone of the 
communities they visited. One man remarked: 

I used to see men coming to town to get drunk every Saturday night, and. now, since 
the local-option law, these same men come in Saturday afternoon driving their wives 
and children in a wagon and buying the various necessities of life. 

Another drummer remarked that in a group where there were a 
number of dry and one wet town the wet town was the only one that 
had not sufficient spirit (of the right sort) to support a baseball team ; 
others observed a general improvement and elevation in the tone of 
the communities they visited, and coincident with this there was an 
improvement in their own business relations; they found the local- 
option towns better places in which to do business. 

That which is by many considered the greatest movement in mod- 
ern times, namely, altruism, is foreshadowed in the writings of Moses 
in Genesis 3, where Cain impudently asks, "Am I my brother's 
keeper?" As a result of this attitude we see him driven out crying, 
"My punishment is greater than I can bear." 

He who confesses that he is his brother's keeper will let alcohol 
alone and will fight it as the deadliest peril that has ever threatened 
to engulf our race. 

This is the age of great professions of altruism. A true altruism 
will indignantly reject as a beverage to be taken for pleasure that 
which can only be had at such an enormous percentage in the de- 
struction of life and morals. 

Finally, let me add that were this whole community to adopt at 
once the will of this assembly and to sweep alcohol from the land I 
would have no hope of any permanent betterment, unless with the 
movement there went that dependence on God through Christ to 
whom the Christian looks for all that is good and transforming and 
effective in his life. A real moral principle is transforming in its 
efficacy; mere repression is not transformation. Transformation is 
wrought in the soul when it stands consciously before God with the 
desire of seeing sin and dealing with it according to His will. 

SUMMARY. 

(1) Alcohol is nonefficient as a food, a most awful, wasteful sub- 
stitute. 

(2) May be classed as a drug and a poison. 

(3) Has no rightful position as a medicine. 

(4) Destroys individual, domestic, and civic felicity. 

(5) Increases taxation by filling prisons, madhouses, and work- 
houses. 

(6) Greatest foe to civilization in heathen lands. 

(7) Therefore could be wholly abolished with profit. 

(8) Therefore, as one of the human family,- an individual member 
has no right to introduce into the household or use for his own 
pleasure even moderately that which may hurt even one other mem- 
ber or set at work an evil influence he has no well-grounded hope of 
controlling. 



ALCOHOL BRIEFLY VIEWED FROM A MODERN STAND- 
POINT. 



By B. 0. Keister, M. D., 
Superintendent Sanitarium for Mental and Nervous Diseases. 



In this age of scientific progress we are confronted by many 
important problems, the proper solution of which requires the most 
careful thought and painstaking investigation. 

A few months ago it was the writer's privilege and honor to attend, 
as one of the official delegates, that grand scientific meeting held in 
this city (Washington), the International Congress on Tuberculosis, 
and to add his mite toward solving the great problem of eradicating 
from this country the curse of tuberculosis. 

The great amount of good accomplished for humanity by this 
convention of liberal-hearted, broad-minded scientific men of the 
medical profession remains to be seen. But, judging from the 
progress already made along certain lines during the few months that 
have elapsed since the convention, we may reasonably infer that a 
general revolution is now in progress, and that the day is rapidly 
approaching when the curse of tuberculosis will be driven from the 
face of the earth. 

We are to-day confronted by even a greater problem than that of 
the " great white plague/' and the solution of which demands greater 
effort, deeper thought, and a more thorough investigation on the 
part of educated men and scientists. 

We have here a curse in disguise, "a wolf in sheep's clothing," 
that is making shipwreck of no less than 150,000 homes in the United 
States annually, and costing the United States for crime, pauperism, 
insanity, etc., no less than $1,884,027,982 yearly. 

We have in the United States at this time about three million hard 
drinkers, who have been taught and made to believe that alcohol 
when taken as a beverage is a mild stimulant and pleasant tonic. 

From the above data and a few scientific facts that will follow in 
this paper you may be able, with some degree of precision, to get a 
partial view of the landscape that now confronts us. 

In approaching this great subject with its varied and complexing 
avenues, over which so many of our older writers have traveled and 
stumbled, I can not but feel my inability, as well as some degree of 
trepidation, in attempting to grapple with such a monster problem. 

In our recent laboratory researches and clinical experience with 
instruments of precision in the scientific study of alcohol and its 
physiological action on the human system we find it rather difficult 
to reconcile our more recent findings to the theories and practices of 
our forefathers. 

127 



128 THE ALCOHOLIC PROBLEM. 

This, however, is quite natural when we consider the many disad- 
vantages under which our older writers labored in not having the 
laboratory training and equipment that are so absolutely necessary 
to make the proper research and scientific study of this subject. 

Recent investigation clearly disproves the old theory of alcohol 
being a heart stimulant. It no longer lays any claim to its supposed 
power of augmenting the heart's action, but, on the contrary, it 
slowly depresses the action of the heart muscle and ultimately para- 
lyzes both the muscle and the delicate nerves of the heart. This 
paralysis of the cardiac nerves largely accounts for the acute dilatation 
and fatal failure of this organ in persons who have taken large quan- 
tities of alcoholic drinks. 

The common practice of administering some form of alcoholic 
liquid as a restorative in cases of fainting is contra-indicated, and the 
deception should be discountenanced by educated people. This rule 
applies with even greater force to cases of shock. Recent investiga- 
tions have shown that alcohol administered in any form aggravates 
the conditions resulting from shock. 

When taken into the system in any form, either as a medicine in 
small quantities or as a beverage at regular intervals, it acts in a very 
deleterious manner on the blood circulation by its paralyzing effect 
on the delicate nerves that supply the blood vessels, causing the lat- 
ter to dilate or expand, and thereby admit a larger supply of blood 
which is carried to the surface and outer extremities of the body, 
causing the heart to do an extra amount of hard pumping in order 
to keep the dilated vessels filled with blood. 

This extra work on the part of the heart deceived our older writers 
and practitioners into the belief that this organ was stimulated by 
the alcoholic beverage, when in reality it was made weaker from 
overwork and the depressing effects of the alcohol on the cardiac 
nerves. Not only the cardiac nerves, but the great sympathetic sys- 
tem of nerves, are more or less affected by the anesthetic and nar- 
cotic influence of the alcohol. It is a recognized fact in clinical 
pathology that toxic doses of alcohol are capable of paralyzing the 
vasomotor center, and thereby causing dilatation of the blood vessels. 
Chloral is capable of producing these same results. Clinical observa- 
tion confirms all this. And it is a fact that when this condition 
exists in a person who has been taking large quantities of alcoholic 
drinks he becomes very weak and pale, the arterial and venous 
pressure falls, and the heart receives an insufficient supply of blood; 
the pulse soon becomes soft and very rapid, and finally syncope 
supervenes. 

These physiological effects of alcohol are more or less observable 
according to the quantity administered and the length of intervals 
between doses. 

We also find by clinical and microscopic observation that by the 
constant but moderate use of alcohol a hardening of the walls of the 
blood vessels, which is soon followed by a thickening, due to an 
increase of fibrous tissue, which leads to a lack of normal elasticity 
and contractility on the part of the vessel walls. We then have a 
delay in the blood current, and finally a stagnation or stasis of the 
circulation. This condition may occur in any part of the body or 
in any of the organs, and is known to physicians as fibrous or fatty 
degeneration. 



THE ALCOHOLIC PROBLEM. 129 

With this abnormal condition of the blood vessels in the brain, we 
may, on the slightest provocation, such as a sudden fright, a hearty 
meal, or anything that may cause undue agitation of the heart, have 
a rupture of a blood vessel, followed by paralysis or apoplexy. With 
this condition of the blood vessels of the liver and kidne}^s, we may 
have such a change in the functions of these organs as will give rise 
to symptoms that are equally as alarming. 

These pathological conditions, according to microscopic investiga- 
tion, are brought about by no other cause, old age excepted, than 
alcoholic drinking. 

It is a true saying that "a man is no older, no younger, and no 
stronger than his blood vessels." 

We have a most deplorable condition of the vessels, the cells, and 
walls of the stomach in persons addicted to the moderate use of 
alcohol, giving rise to the many and varied symptoms of dyspepsia, 
such as slowing the process of digestion by the destructive effects of 
alcohol on the pepsin of the gastric juice. It is claimed that one 
grain of alcohol is capable of destroying 800 grains of pepsin. 

One of the well-known characteristics of alcohol is its power to 
extract water from any object with which it comes in contact, hence 
its deleterious effect on the blood corpuscles, which contain 79 per 
cent of water, also the gastric juice, which contains 97 per cent of 
water, the pancreatic juice, which contains 90 per cent water, the saliva, 
which contains 99 per cent water, bile, 87 per cent water, muscle, 75 
per cent water, brain, 80 per cent water, etc. It extracts the moisture 
from the 5,000,000 little cells that supply the gastric juice to the 
stomach, and destroys the protoplasm of the epithelial cells of the 
lining of the stomach, and in so doing the functions of this important 
organ of digestion are almost obliterated. We find that the entire 
alimentary canal is more or less affected by this same destructive 
process; in fact, no part of the human structure escapes the destruc- 
tive influence of this insidious enemy. 

The brain and nerves being of a watery character (80 per cent 
water) renders them very susceptible to the influence of alcohol. 
The microscope shows that grave alterations i "eke place in the pro- 
toplasm of both the nerve cell and fiber under the action of alcohol 
after it has been freely taken for some time. It is a well-known fact 
that alcohol is a powerful protoplasmic poison, it having a special 
selective affinity for the delicate cells of the brain and nervous system, 
with whose function and capacity it interferes even at a very early 
stage, and finally causing permanent gross alterations in the tissue, 
which are demonstrable to both the naked eye and through the 
microscope. A cell damaged in this way never recovers. It has 
been demonstrated by clinical observation that alcohol has been 
found pent up in small sacs on the brain in persons who have been 
chronic drinkers. It may be found in various quantities. "Enough 
alcohol has been repeatedly found in the brain of a dead toper to 
spoon out into an open dish and set on fire." We may have, as a result 
of this accumulation of alcohol, pressure on the brain substance, 
giving rise to such diseases as apoplexy, epilepsy, delirium, and 
insanity. The brain is hardened by the alcohol on account of its 
power of absorbing the water therefrom, causing a very marked dis- 
turbance in the transmission of thought and nerve force, impairing 
to a certain extent all the mental faculties. When we consider these 

S. Doc. 48, 61-1 9 



130 THE ALCOHOLIC PROBLEM. 

pathological conditions of the brain and nerves, wrought by alcohol, 
is it any wonder that we have such an increase of nervous diseases, 
insanity, epilepsy, feeble-mindedness, both hereditary and acquired? 

Parental intoxication tends to produce impulsive degenerates and 
moral imbeciles. The brunt of the evil heritage caused by alcoholism 
falls upon the nervous system of the next generation. It may not 
always be recognizable immediately, although during early infancy 
impaired nerve vitality frequently shows itself in convulsions, menin- 
gitis, and other forms of nervous debilities. Many children of alco- 
holic parentage show signs of stupidity, mental deficiency, moral 
instability, and lack of normal control, while others exhibit idiocy, 
epilepsy, and hysteria, together with various abnormal cravings. 

In a single reformatory school in the city of Berlin hereditary taint 
due to parental alcoholism is shown in 67 per cent of all pupils. Public 
attention is now being directed to the " problem of the feeble-minded," 
and those experts who have devoted most attention to the subject 
regard alcohol as certainly one of the most prolific causative factors 
in the deterioration of brain tissue, which lies at the real root of the 
mental inability and feeble-mindedness of so many human beings of 
this the twentieth century civilization. Of the 55,000 school children 
examined in New York City in 1901 by Doctor MacNicholl, 58 per 
cent were below the required standard of intelligence, 17 per cent 
being actual dullards, bordering on imbecility. The family histories 
of 3,711 of the children were traced through three generations. This 
was done in great detail with regard to the taking of alcohol. Of the 
children of abstaining parents and abstaining grandparents only 4 per 
cent were " dullards," whereas of the children of abstaining parents, 
but drinking grandparents, 78 per cent were dullards or feeble-minded. 

If one-half of the money expended for the mental degenerates, 
idiots, imbeciles, epileptics, and paupers caused by alcoholic drinking 
were properly spent toward the prevention of these conditions, we 
would not only save millions of dollars, but in addition to this we 
would soon have a healthier and more refined civilization. 

Our friends of the " Fatherland, " the Germans, have made some 
recent pathological discoveries resulting from the much beer drink- 
ing of that country. It is known among the physicians connected 
with the large hospitals of Germany as " beer-drinkers' disease, "and 
is recognized by a special condition of unhealthy enlargement of the 
heart, due to dilatation, accompanied by some increase of tissue and 
fat. 

It is reliably reported that one in every sixteen of the hospital 
patients in Munich die from this disease. 

Since beer drinking has become so popular in the United States dur- 
ing the past quarter of a century, we may anticipate about the same 
results. In fact, when we consider the greater quantity of the stronger 
drinks to which the American people are addicted we may expect a 
higher rate of mortality among the beer-drinking classes of this 
country. 

This disease manifests its worst symptoms in persons between the 
ages of 40 and 60 years. It is not generally realized by the laity that 
such small amounts of alcohol taken in the form of lager beer and 
other soft drinks is fraught with so much danger, but it is nevertheless 
true, as well as appalling to think of. At such an age a man should be 
at his best, both mentally and physically, and with prospects of a 
good old age. Their loss to the community in which they reside is 



THE ALCOHOLIC PKOBLEM. 131 

incalculable when we consider the deplorable fact that many of our 
most prominent citizens and leaders or men are numbered among the 
beer drinkers of our country. 

In considering the matter of national physical proficiency as well as 
national pride, steps of a most radical character should be taken 
toward removing the cause of these abnormal conditions. 

When we consider the high standard of mental and physical require- 
ments for military service of some of the other progressive nations, it 
is high time for our Federal Government to take cognizance of these 
facts and conditions. 

It is thought by some of our learned thinkers that with a con- 
tinuance of our present rate of deterioration, both mentally and 
physically as a nation, it will be only a matter of time when we will be 
classed with France and some other wine and alcoholic drinking 
nations of the earth. 

It is a well-known fact that this marked deterioration on the part of 
the wine and beer drinking nations is now provoking the most lively 
consideration by educated men and heads of these various govern- 
ments. 

The most careful investigation reveals the fact that alcoholic bever- 
ages are no longer entitled to a place in the army or navy, in the camp, 
or on the field of battle. It is now recognized by our best authorities 
on military matters that the most severe exertions can be best 
endured, either in cold or hot climates, without any form of alcoholic 
drinks. It is a most significant fact that the Boer army withstood the 
long siege of warfare with England and displayed their wonderful 
power of endurance over their warm-blooded antagonists without 
spirituous drinks of any kind. 

On the English side we have the comments of Sir Frederick Treves, 
who commanded the relief column of 30,000 soldiers that marched onto 
Ladysmith during that extremely hot weather when so man}^ of the 
soldiers lost their lives on account of the great humidity and extreme 
heat. He remarked that the first men who dropped out of 4 the ranks 
of this enormous column " were not the tall men or the short men, not 
the big men or the little men — they were the drinkers, and they 
dropped out as clearly as if they had been labeled with a big letter on 
their backs." 

It was claimed by some of our older writers that spirituous drinks 
relieved fatigue and made privation more endurable. This, in a meas- 
ure, is true when applied to the drinker and to the coward who does 
not measure the extent of the danger to which he is exposed, and on 
that account scorns the thought of danger. In the earlier times, 
when the method of fighting was to run down the antagonist by a wild 
dash, alcohol no doubt had its devilish effects on the brain. But 
modern scientific warfare has other features to reckon with; tran- 
quillity, cool deliberation, iron endurance, a steady hand, a clear eye, 
a quick decision, etc., are some of the necessary qualifications which 
the warrior of the present day must possess in order to make the rifle 
in his hand a formidable weapon. He must be imbued with courage 
and loyalty that springs from love of family and country, and not 
with that drunken tumbling into danger with which one whose brain 
is clouded with alcohol rushes into battle. 

As previously intimated, in considering the enormous fact that we 
have in the United States about three million hard drinkers whose 
ages vary about as much as the ages of those who are now enlisted in 



132 THE ALCOHOLIC PROBLEM. 

our navy and standing army, saying nothing of the millions of young 
and middle-aged moderate drinkers of this country who are following 
in the footsteps of their parents and grandparents, and who will be 
followed by their children and grandchildren, is it not about time for 
the scholar and scientist to speak out a warning note of no uncertain 
tone? Should we not, as a convention of broad-minded citizens and 
conservators of the public health and public weal, make a bold effort 
toward arousing the slumbering senses and open the e} 7 es of our 
Federal Government to the stern realities of the picture that now con- 
fronts us as a nation ? 

Mrs. M. J. Annable, of Brooklyn, N. Y., vouches for the record of one 
woman who, having been reared in the atmosphere of the saloon and 
the lowest form of immoralities, died a few years ago at the age of 51. 
Her descendants were traced from 1827 to 1902, and numbered in all 
800, 700 of whom were criminals, 342 were confirmed drunkards, 127 
were immoral women (prostitutes), and 37 were murderers, and they 
were executed for their crimes. This woman, through her progeny, 
cost the United States $3,000,000. 

In conclusion, permit me to present for your serious consideration 
a few side pictures, in the form of statistics, that continue to "bob 
up" in the background demanding attention. 

First. We have now in the United States 3,640,000 hard drinkers 
of alcoholic beverages, 125,000 of whom die annually from the direct 
effects of alcohol; over 5,000 of these take their own lives. 

Second. During the past four years alcohol killed more people in 
the United States than were killed by bullets during the four years 
of our civil war. In 1907 there were 10,782 suicides in the United 
States. 

Third. The use of alcohol as a beverage costs the United States 
annually $1,200,000,000. 

Fourth. Eighty-five per cent of the crime, 75 per cent of the 
pauperism, and 50 per cent of the insanity of the United States are 
caused by alcohol. 

Fifth. Seventy-five per cent of the diseases of fashionable life are 
caused by alcoholic beverages. 

Sixth. Forty per cent of all diseases of the liver and kidneys is 
caused by alcoholic drinks. 

Seventh. Sixty per cent of the inmates of all reformatory schools 
are the descendants of parents or grandparents who were addicted 
to the use of alcohol. 

Eighth. Sixty per cent of all the imbeciles and epileptics of the 
United States is caused by the hereditary effects of alcohol. 

Ninth. In 1905 the amount of alcoholic beverages consumed in 
the United States was 1,694,392,765 gallons; 1,494,191,325 gallons 
was lager beer. 

Tenth. In the year 1890 the liquor traffic paid into the United 
States Treasury $157,485,982. It cost the people of the United 
States directly and indirectly $1,884,027,982. 

The late Mr. Gladstone made the emphatic statement that alcohol 
was a greater curse to any nation than war, famine, and pestilence 
combined. 

Notwithstanding this array of scientific facts and figures, our 
federal and state governments continue to issue license for the sale 
of a poisonous beverage that is slowly but surely destroying our 
nation. 



THE EFFECT OF ALCOHOL ON TEMPERAMENT AS IT 
RELATES TO RACE AND NATIONALITY. 



By Willis B. Parks, Atlanta, Ga., 
Editor of the Altruist. 



Much has been written in regard to the effect of alcohol on the 
human s} r stem, taking humanity as a whole. The consensus of 
opinion, according to the results of experimental research and inves- 
tigation, is that alcohol is more or less deleterious to the human sys- 
tem, either in large or small doses. We may say, then, when alcohol 
is ingested into the human system that the effect is pathological. 

We will ask permission in this short paper to discuss the effect of 
alcohol manifested according to temperament of the individual with 
regard to his race or nationality. However, we may remark that 
alcohol first gained its stronghold on humanity by its seductive effect 
when taken as a beverage. 

This being true, no doubt, but that it was the untutored laity that 
suggested to the physician that this delusive beverage should have 
first place as a panacea for most of the ills that humanity was then 
heir to. We acknowledge with shame and regret that many physi- 
cians of this enlightened day are still following the same old tradi- 
tional suggestion. As we consider the wide divergence in tempera- 
ment, between individuals of different nationalities, even the simple 
habits and temperament of primitive man, we find that they all come 
under the same ban, of the one curse, known as alcohol. 

For instance, the unsuspecting phlegmatic Englishman, who is gen- 
erally characterized as a good feeder, even to the extreme of gor- 
mandizing, permits the delusive beverage to prolong his repast until 
he becomes an habituate with his gouty diathesis. 

The nervous and impetuous Frenchman v^ould seek the volatile 
absinthe for the purpose of soothing his quaking nerves, that he may 
coolly challenge to the field of honor the one who had on some occa- 
sion given an offensive "snub." 

While the good-natured lymphatic German, through his social 
habits, will often repeat his order for "zwei Bier," while he laughs the 
evening away with his friends until finally he succumbs to ' ' Leber- 
krankheit" before he reaches the stage of delirium tremens. 

The bilious temperament of the Italian predisposes him to drink 
deep the "wine that moveth itself aright in the cup," that it might 
give him courage to plunge the stiletto into the vitals of his adversary. 

But of all the inebriates who are a menace and a terror to his 
country, it is the brusk heavy-shod Russian, who drinks the intoxi- 
cating vodka that he might more easily carry the heavy yoke of 
oppression until in his fiery frenzy he revolts at oppression and hurls 
the bomb at the carriage of the passing despot. 

133 



134 THE ALCOHOLIC PKOBLEM. 

The nervo-sanguine Irishman feels that it is his first tew drinks 
that sharpen his mother wit, but he usually closes the scene with a 
drunken broil with fist and skull fight, even on the occasion of cele- 
brating the anniversary of "St. Patrick's day in the morning." 
Through his good nature he becomes one of the most helpless inebri- 
ates. 

The sanguine bonnie Scotchman will drink and sing, and sing and 
drink his intoxicating Scotch whisky until he reels and falls to sleep, 
the prolonged sleep of a Rip Van Winkle, or ends his pitiful career 
by the sad termination of alcohol paresis. 

In considering the Jew and alcohol, his racial identity and tra- 
ditional peculiarities eliminate, in a measure, the effect of alcohol as 
it relates to his temperament. The question has been asked, "Is the 
Jew immune to alcohol?" "According to some authors, the influence 
of race has more to do with immunity to alcohol than temperament 
or religion." They say that the Jew must possess a hereditary 
immunity to narcotic poisons, and in particular alcoholic beverages. 
It is pointed out by those who have studied the question : First, the 
Jews form a small, very compact community, and because of this 
intimate cohesion, of their isolation from the rest of the population, 
they are distinguished by very rigorous customs; second, they never 
adopt occupations necessitating great physical effort. 

Judaism generally has preserved up to the present that character of a collective 
and social bond which other nations and races have lost somewhat, and it is this very 
force of cohesion and concentration of the compact community that preserves the 
great mass of Jews from alcoholism. 

Come with me, if you please, across the Atlantic into one of the 
greatest countries that has been populated by a civilized people — the 
United States of America. Here we find a heterogeneous, enterprising 
people, with the highest mark of civilization and progress. It would 
be practically impossible to classify this heterogeneous people with a 
specific temperament, but here we find a blending of all the temper- 
aments that can be found separate and distinct in each of the Euro- 
pean countries, and, as might be supposed, it is here that every type 
of inebriety is conspicuously evident. 

We know that alcohol heredity has not had as long a period to 
develop in America as it has had in European countries. Yet, on 
account of environment and the heterogeneous temperaments we 
believe that we have it here in this country marked even with more 
heredity and neurotic tendencies. 

Such an abnormal condition seems to be contradictory, for those 
who came over in the Mayflower and those who came later had all 
of the elements of heredity acquired from the mother countries. 
But it is a historical fact that on account of the deprivations suffered 
by those who were to settle a new and undeveloped country the 
tendency was to modify the habits of high living and much wine 
drinking. As a consequence, for quite a long period the people of 
this then new country enjoyed sobriety long enough, in a measure, 
to overcome the ancestral alcohol heredity. But, as indicated before, 
the environments and the flattering inducements for fortune and 
fame, together with heterogeneous temperaments, have prematurely 
precipitated a people of the highest type of American achievement 
into an alarming state of drunkenness and inebriety. 



THE ALCOHOLIC PROBLEM. 135 

In considering the effect of alcohol manifested in temperament of 
race and nationality we must include the North American Indian and 
the negro, which are two races distinct from the Caucasian. Without 
special investigation we doubt very much if there could be found a 
typical inebriate among our Indians; but no doubt, on account of 
his ancestral proclivities of hunting for the purpose of killing and 
slaughtering game, he has the deep predominating spirit of murder 
in his heart. This being true, he becomes a serious menace when his 
restraints are released by alcohol intoxication. 

When we attempt to consider the effect of alcohol in regard to the 
temperament of the negro as a race, we are necessarily in a measure 
confronted with the much perplexed question — the negro problem. 
As a native of the South, I have made a study and some investigations 
as it regards the negro and alcohol. After investigations in hospitals 
and in all parts of the South I have never been able to find a con- 
firmed inebriate among the negro race. While the negro is immune 
from dipsomania, yet he seems to have a special thirst for all kinds of 
intoxication. He is an easy victim to cocaine, probably from an 
economical standpoint, for he can obtain the intoxicating effect from 
cocaine at a smaller cost than from alcoholics. This thirst for intoxi- 
cants may be explained on account of his recent savage state, upon 
the principle that there is constant strife between his savage state and 
the civilized state, intoxication having a tendency to relieve the 
tension between savagery and civilization. The reason that he is 
immune from dipsomania is that he did not drink alcoholics to excess 
during his slavery and that there has not been time, in a little over 
forty years, since slavery was abolished to produce hereditary con- 
ditions. I will admit that it is a common occurrence to see the negro 
drunk; but a debauch does not affect him as it does the white man, for 
the negro can lay all of one day in extreme drunkenness and resume 
even hard manual labor with very little inconvenience the next day. 
I have never known delirium tremens among the negro race, which 
also strengthens the theory that the negro is not a victim to alcohol 
heredity. 

Another interesting feature is that the mulatto, even with great 
excess of white blood, seems to have all of the characteristics of the 
full-blooded negro in this respect. Just how he should be immune 
from dipsomania or delirium tremens with a very little negro blood 
in his veins is more than I can account for. 

In order to appreciate some facts that are evident it will be neces- 
sary to consider some peculiarities that are characteristic of the negro. 
The negro seems to have three attributes that predominate in his 
make-up — emotion, imitation, and lust. It is through his imitative 
faculties that he can easily acquire education, which is more percep- 
tive than reflective. Higher education does not obliterate his three 
attributes, but seems only to change their manifestation. For 
instance, higher education will curb his lust while it engenders a fond 
hope of social equality and miscegenation. We of the south are 
heartily in favor of educating the negro, but we believe that the time 
required to educate him correctly should be hundreds of years 
instead of forty. His religious tendencies, which are easily called 
into extreme action, come through his characteristic emotional 
nature. It is remarkable, to those who do not understand the negro, 



136 THE ALCOHOLIC PROBLEM. 

that he of the middle class will without hesitation exhibit great reli- 
gious enthusiasm soon after leaving the scene of the chicken roost. 

The lustful proclivities of the negro come through his predominating 
animal nature, and with the lower class, when under the influence of 
alcohol intoxication, he will at times attempt to commit the unnamed 
crime when almost in sight of the lynching mob. 

Mr. President and gentlemen, who can marvel at the wave of state- 
wide prohibition through the South, for it has come to the period that 
without it the safety of our Southern womanhood is in jeopardy. 

I will close with the remark that I wish it was practical for this 
august body of honest, hard-working scientific men to memorialize 
Congress to pass laws for the purpose of curbing the shipment of 
whisky into prohibition States. 



THE PHYSICIANS' PART IN THE TEMPERANCE MOVEMENT. 



By Miss Cora Frances Stoddard, 
Secretary oj the Scientific Temperance Federation Bureau, Boston, Mass. 



Last autumn the New York Times published a symposium on 
alcohol, wherein various and diverse views were expressed by a 
number of more or less well-known physicians and scientists. 
Shortly afterwards Doctor Jacobi, of New York, published in the New 
York Medical Record a letter of protest against the appearance of 
such articles in the secular press and asked if space was lacking in 
medical journals for such discussions. 

The next issue of the Record contained a counter opinion by Dr. 
J. M. W. Kitchen, of New Jersey, who said that the general public 
was calling on the medical profession to make a more definite state- 
ment as to the physical effects on the human body of the moderate 
use of alcohol than has yet been declared. 

This latter opinion seems to be the one to which many physicians 
in all parts of the country are arriving. The word " prophylaxis " is 
beginning to be applied to alcoholism, as well as to typhoid fever, 
tuberculosis, and social disease. 

The emphatic declaration of the Journal of the American Medical 
Association last September that the medical profession as a body 
should stand for temperance as one great essential of public health 
has been copied by the official organ of the American Health League, 
which is said to be preparing to take a part in the temperance move- 
ment. 

This proposal of the medical profession to take a part in the struggle 
against alcoholism leads to the question, Where is their help most 
needed ? 

Part of the answer is indicated in the letter of Doctor Kitchen, cited 
above. He says people need the knowledge which physicians can give 
them on the following points: 

(1) The effects of the habitual use of small quantities. 

(2) The grasp of habit. 

(3) Whether the pleasures of indulgence can offset the resulting 
evils. 

(4) The correct interpretation of the seeming stimulation. 

(5) The relation of moderation to immoderation and loss of self- 
control. 

There are other points on which physicians are also needed as 
teachers. The liquor traffic is industriously flooding the mails with 
false claims for its wares. A finely illustrated pamphlet recommends 
a certain brand of whisky as a "bracer" when one is fagged; as a relief 

137 



138 THE ALCOHOLIC PKOBLEM. 

for summer "cramps;" to warm one up in winter and fortify him 
against chills; as a component of "food-drinks" for the convalescent; 
as an ingredient in "punches" for social functions. 

An ale is credited, in flaring posters, as an aid to the muscle-worker 
and the brain- worker. It is said to "digest food" and "make red 
blood." 

A widely circulated wine brochure urges the use of wine ' ' to remove 
drunkenness ; " to be served as a ration in the army and navy ; to be 
given to children with their meals that they may grow up sober ; to be 
used by ladies for invigoration when they are out shopping, or to 
serve in place of tea to callers. 

In newspaper advertisements . and pamphlets mailed to voters are 
the claims that beer is a muscle-building and blood-making food; 
a liquid food that strengthens and gives tone to the whole system; 
that it aids digestion, improves assimilation, and keeps up the weight 
and strength. 

No class of people can so effectively correct the false impressions 
and mischievous suggestions created by these means as can the 
physicians. 

Another class of false valuations has grown out of the recommenda- 
tions of physicians in the past, and can only be corrected by the better 
informed physicians of to-day. Among the practices thus arising 
are the use of beer and port by nursing mothers to increase their milk 
supply; the use of gin for worrying babies and young girls to relieve 
pain; of "hot sling" to break up a cold; and eggnog to nourish or 
strengthen the delicate. 

On all these points the people are being misled; have long been 
misled, and the physician is the one to whom they turn for light. 
He can and should be their rescuer from the inevitable consequences 
of ignorance. 

Are all physicians prepared to be safe teachers concerning the 
beverage use of alcohol? The diverse opinions expressed in the 
symposium in the New York Times raises doubt as to whether many 
of the published expressions by physicians are based upon adequate 
examination of the existing evidence. If not, is the material needed 
for making a careful study readily available? 

The Index Medicus is a tolerably complete guide to the most 
valuable and authentic works on most subjects which physicians 
are called upon to investigate; but one going to it for matter on the 
alcohol question misses much valuable testimony that has been given 
indirectly in the discussion of other subjects and is not therefore 
indexed under alcohol. Many physicians lack also the time required 
for obtaining the material referred to and for reading and translating. 

To physicians who are truly desirous of helping in the rescue work 
demanded of them by the alcoholic customs of the times, the value of 
a bureau that has been steadily compiling for years the scientific 
literature on this question need not be emphasized. 

Such a bureau is in existence under the care of the Scientific Tem- 
perance Federation of Boston. It contains not only the standard 
articles on alcohol in its relation to the human economy that have 
appeared in the principal medical journals, many of them translated 
into English from the German or French, but gleanings from number- 
less others not to be traced under the head of alcohol, besides many 
valuable reports coming from memoirs and transactions that have not 



THE ALCOHOLIC PKOBLEM. 139 

reached the editors of the Index Medicus. Carefully worked out 
cross references increase the value of the articles. 

Another question that arises in connection with the physician's 
prophylactic work on the alcohol question is how he may most 
quickly and thoroughly disseminate the truths he wishes to teach. 
The Scientific Temperance Federation has established connection 
with the heads of more than twenty state, national, and international 
organizations through whom it can communicate to the remotest 
communities, and it maintains a press circular that carries informa- 
tion by request to over 150 editors representing nearly 10,000,000 
readers. It has as corresponding members several of the leading 
students of this subject, as Professor Kraepelin, of Munich; Professor 
Aschaffeuburg, of Cologne; Professor Laitinen, of Helsingfors, and 
others. 

This organization is ready to use and to be used by the medical 
profession for that enlightenment of the people which alone can make 
the results of any temperance movement lasting. 

Certain definite steps in this popular work have been taken by the 
federation. Through the Press Circular, of which mention has 
already been made, editors of some of the most influential publica- 
tions in the country are being kept in touch with the progress of 
scientific inquiry on the alcoholic question. 

The School Physiology Journal, primarily designed to assist 
teachers in giving accurate, up-to-date information in this subject to 
the young people in the public schools, is publishing each month 
articles of much value, many of them appearing in English for the 
first time, which are appreciated not only by teachers but by a wider 
circle of interested readers to whom this basis of fact constitutes the 
most convincing argument for temperance effort. 

Popular literature has been prepared on wine and beer, exposing 
the fallacies of the arguments made by their manufacturers for their 
use, or pointing out the relation of drink to tuberculosis and other 
infectious diseases, and to degeneracy of various lands. 

A loan exhibit of colored charts prepared by the federation, repre- 
senting diagrammatic ally the results of scientific study of the rela- 
tion of alcohol to daily life, is proving to be an attractive and convinc- 
ing educational method. Nearly thirty charts are now available and 
are used as illustrative material in informal addresses or, being self- 
explanatory, are used in the same manner as the traveling tubercu- 
losis exhibits. 

For reaching larger audiences, a popular stereoptican lecture is in 
use, illustrating the relation of drink to physical and mental efficiency, 
to cell life and development, to infectious diseases and other practical 
questions, all being based upon the facts ascertained by scientific 
research. 

The scientific study of the alcohol question has taken it out of the 
realm of individual opinion and has placed it on the firm foundation 
of facts, which are not only convincing but fascinating when well 
presented. All arguments against the beverage use or sale of alcoholic 
drinks, reduced to their last analysis come back to these now well- 
established facts. Here, then, lies a most hopeful field of effort, 
and in this field the Scientific Temperance Federation is ready to 
cooperate with the physician who uses prophylactic methods, with the 
social worker who has learned that the ultimate elimination of the 
ills that afflict society lies in their prevention. 



THE FUTURE OF THE ALCOHOLIC PROBLEM. 



By T. D. Crothers, M. D., Hartford, Conn., 
Superintendent Walnut Lodge Hospital. 



Public opinion in 1860 was distracted and confused. There were 
signs of revolution and change, and everyone was reading these 
signs and predicting what they meant. 

•The political horizon was a great tumultuous cloud bank of con- 
flicting theories and opinions. To-day, in 1 909, the political and social 
sky is overcast with doubts, theories, dogmatic predictions, and opin- 
ions of every sort concerning the meaning and direction of the great 
temperance movements, and a feeling of alarm is pervading all 
society concerning alcohol and the diseases associated with it. 

The efforts of reformers have assumed startling prominence with 
revolutionary consequences, and the dealers in spirits are alarmed 
and read in these movements the doom of their business. 

Everywhere — in the pulpit, press, and platforms — are explana- 
tions, predictions, and appeals concerning the alcoholic problem, but 
through all this there are unmistakable signs of the direction of the 
movement and the coming changes that are sure to follow. 

In. 1860 nothing was very clear and settled. There was a conflict 
ahead, and no one could predict where it would end. To-day there 
are unmistakable indications, through the gloom and confusion of 
theories, that a new era is coming, and that the solution of the great 
problem, with all its influences, is not far away. 

Every advance in scientific study of disease and degeneration 
shows that alcohol is one of the most prominent agents and is very 
vitally concerned in the diseases and destruction of the human race. 
Statistical studies of the causes of accidents, injuries, diseases, and 
the great forces of heredity which enter into our civilization, bring out 
the same fact in greater prominence, that alcohol in some form is the 
most influential factor of these losses. 

Medical, sociological, and economical studies all confirm these 
facts, and make prominent the conviction that alcohol in some way 
is a source of clanger, recognized imperfectly, and yet powerful 
beyond measure, in degeneration and increased mortality. 

These facts have created a sense of alarm in the public mind which 
is materializing in various ways and apparent in very remarkable 
forms. 

Thus in the legislatures now in session in 34 States of the Union 
there have been introduced 221 laws restricting and regulating the 
use of alcohol as a beverage. 

140 



THE ALCOHOLIC PROBLEM. 141 

Sixteen of these laws urge the prohibition of both its manufacture 
and sale. Ninety-two laws concern the sale of spirits and the con- 
trol of saloons, and others refer to punishment for violation of various 
enactments concerning the alcohol question. 

A second indication, equally significant, is the fact that over two- 
thirds of the territory of the United States has specifically voted to 
prevent the sale of alcohol as a beverage. Such sections are called 
"drys." 

There are over 1,000,000 men and women organized in societies 
and working through churches for the specific purpose of driving out 
the saloons and stopping the beverage use of alcohol. 

In addition to this, there are over half a million voters who have 
expressed the same conviction in some form or other, although not 
in organized parties. 

From these facts alone it is evident that the movement toward 
total abstinence is not the enthusiasm of reformers or a matter of 
sentiment among hysterical men and women, or even a psychological 
craze, but a deep-settled conviction of danger and a consciousness 
of the possibility of removing and destroying it. 

It is becoming more and more evident every day that the theories 
which have come down from the past, and opinions and conclusions 
of our forefathers, however respectable and apparently based on wide 
experience, can not be accepted unless they are able to pass the bar 
of scientific inquiry and be judged in the light of modern science. 

Thus the great evils, diseases, and questions of mortality, losses 
and obstacles which limit progression and development, are to be 
measured by the same standard and tested by a critical examination 
of the facts and their meaning. 

The theory that alcohol as a beverage has tonic or stimulant 
properties, that came down through the ages to us with historical 
prestige, must be sustained by the laboratory research and clinical 
experience of this new century if it be accepted. 

Within a half century research and experience have pointed out 
the errors of the past theories, and now it is proven beyond question 
that alcohol is simply a narcotic and depressant in its effects ; that 
it has no stimulant or tonic properties, and that as a beverage it has 
no claim or reason for existence. 

Consumption, insanity, epidemic diseases, and many of the great 
scourges of civilization are found to be the direct result of causes 
which are traceable and which move with a uniformity and certainty 
that can not be mistaken. 

In the same way alcoholism, inebriety, marked by an insanelike 
impulse, or craze, for spirits with a full knowledge of the results, are 
traceable to causes and to physical conditions which can be under- 
stood, controlled, and prevented, with the same certainty as any 
other disease. 

All questions of will power,*, moderate drinking, culture, control, 
have about the same meaning as dispensation of Providence, so often 
used in explanation of the mysteries of life. 

A deep-seated conviction is growing in the public mind that the 
alcoholic problem is a physical and not a moral one, and that the 
same laws which govern the slow development of human life work 
with equal exactness in tearing down and destroying the unfit and 
removing those who disobey the exact requirements of physical laws. 



142 THE ALCOHOLIC PROBLEM. 

The realm of devolution and degeneration is as exact and clear 
as that of evolution and progression. Theories which urge that 
alcohol in some way favors evolution and progression are really 
evidences of degeneration and devolution. Its warmest patrons and 
defenders are the most pronounced promoters of its destructive 
influence upon the race and upon civilization. 

Everywhere the accumulated facts concerning the saloon and its 
influence show that its doom is near and the cosmic consciousness 
of its evil and the tremendous opposition to it show that its disap- 
pearance is only a question of time. 

The pecuniary powers bound up with the manufacture and sale 
of alcohol, while making tremendous efforts to conserve their inter- 
ests and prevent the destruction of their business, are strangely 
oblivious to the great commercial revolution that is rapidly coming 
into prominence. The stupidity of carrying on an organized combat 
with these mighty forces of evolution, and the money and energy 
spent beating the air and shouting to check the race march from the 
lower to the higher, is startling. 

Scientific research has pointed out beyond question that alcohol 
possesses tremendous powers for heat and light which can be made 
force producers equal to electricity. Every year new discoveries 
show that alcohol can be made from a great variety of substances, 
many of which are now regared as waste products, and these can be 
produced very cheaply. 

Already this has become practical in Germany and other conti- 
nental countries where alcohol is manufactured from potatoes, beets, 
roots and other substances, and used for power and light at a cost 
of 20 cents per gallon. 

As a fuel it is far superior to coal, wood, and oil, and in the 
manufacture of electricity it is cheaper than steam. The recent laws 
denaturing alcohol, rendering it poisonous as a beverage has opened 
up a new realm and new uses in the arts and in other directions. 

As a competitor with gas and electricity, it has already been dem- 
onstrated to have equal and greater capacity for power and work. 
Inventors have turned to this problem, and have confirmed the 
wildest expectations and possibilities of its practical use in the world's 
work. 

They have shown beyond question that the only obstacles are the 
discovery of apparatus and means to utilize it. To-day a small 
army of experimenters are working to perfect boilers which will make 
available the tremendous power of alcohol, and lamps and means 
to utilize this new force and turn its vast powers of light and heat 
into commercial channels. 

Already great progress has been made in this direction, and the 
question is simply one of the means and methods of harnessing this 
great new power and turning it into practical uses. It can be made 
cheaply in great abundance on the farm, in the factory, and in every 
section of the country. 

It will do equally as great work as electricity, and with that force it 
will bring about a new and higher civilization, enabling us to use both 
these forces in ways undreamed of at present. 

The great liquor interests with its millions of money will turn to the 
manufacture of this product with greater profit and will find an 
increasing demand for it, and this is a positive indication of its future. 



THE ALCOHOLIC PEOBLEM. 143 

Alcohol as a fuel will take the place of coal, as a power it will supplant 
gasoline, and the great alcoholic problem will merge into the utiliza- 
tion of this force for the benefit of mankind and the world. 

A number of different manufactories in the West have begun to 
change their products from refined liquors to crude alcohols for the 
trade. New inventions and new possible methods are growing in 
many directions. 

Thus a tremendous revolution of industrial energies has already 
begun and is in sight and promises to constitute a new era in the 
economics of the race. The extinction of the saloon will follow early, 
and the change in the breweries and distilleries is bound to come, and 
the frantic efforts of the trade to obstruct will disappear. 

Far-seeing men recognize this already and refuse to take an active 
part in the great proalcoholic struggle. 






ALCOHOL: ITS PLACE IN MEDICAL PRACTICE. 



By, W. H. Waugh, M. D., Chicago, III, 
Editor Clinical Medicine, etc. 



When the writer began the study of medicine, the view prevailed 
that stimulation was but another name for whisky. If any person 
was permitted to die of weakness, it was the doctor's fault for not 
having pushed the whisky. True, we knew that if enough whisky 
was given the mental and physical faculties would be successively 
paralyzed, but we did not find it absolutely necessary then that we 
should be ready to explain everything; and the general truth and 
applicability of the above proposition were not seriously questioned. 

Clinical experience gradually served to weaken this impression 
and the field for the application of alcohol became more and more 
restricted. The conviction was finally forced upon us that alcohol 
is not in any sense a stimulant, and that there is not a solitary clinical 
application that can be made of this agent, for which we have not 
other and better remedies. 

It is now generally admitted that alcohol is in no sense a stimulant 
of either the mental faculties or the physical functions. In any dose 
it depresses the brain, the spinal cord, and the nerves. The increased 
activity sometimes following its administration is not stimulation, 
but due to depression of inhibition, with consequent lack of control. 
This applies to the mental processes. Small doses of alcohol weaken 
self-control and destroy self-consciousness. There is in no sense an 
increase of mental power following. This is true, no matter what the 
dose of alcohol may be or how it is taken. 

It has been conclusively proved that alcohol is not an eliminant. 
After its administration there is often an increase in the excretion of 
urea and uric acid with the urine, and this led some to claim that 
herein lay the remedial virtue of alcohol. But it has been shown 
that this increased excretion is supplied by the food. The liver is so 
occupied with the task of intercepting and excreting the toxic alcohol 
that nitrogenous toxins in the food that would otherwise be thrown 
back by this organ into the bowel for excretion slip by this guardian 
of the vital portal and enter the blood, where they circulate to the 
discomfort and detriment of the individual, to be thrown out by the 
kidneys. In no conceivable condition of the human system could 
such a state of affairs be deemed advantageous. 

From first to last alcohol is a depressant, weakening self-control, 
coordination, and the sway of the central nervous system over the 
physical functions, the control of the ego over the mental faculties. 
What, then, is the true cause of its repute? For there is always a 
reason underlying a popular belief. 

144 



THE ALCOHOLIC PROBLEM. 145 

Without adverting to minor considerations we may say that the 
value of alcohol is due to its power of quieting apprehension, and 
that of relaxing the tension of the blood vessels. One action gives the 
patient a " Dutch courage" that is really due to benumbing that 
sense of danger that might otherwise lead to the avoidance of dis- 
aster. The other allows freer transpiration of heat by the skin and 
somewhat betters nutrition by permitting a freer supply of blood; 
and by relaxing mental, physical, and moral tension induces a pleas- 
ant sense of rest and comfort. I think that as we realize that this 
influence extends to the three spheres comprising our being — the 
mental, the moral, the physical — and as we note how with the habit- 
ual drinker this sense of "ease" becomes continuous, we may see in 
it the sufficient explanation for the fascination exerted by this potent 
agent. 

Relaxation, ease, rest, freedom from the obligations of labor, of 
endeavor, Of conscience, from the spur of duty and the sting of re- 
morse — surely there need be no quest for some mysterious underlying 
need of man's innate being to account for the universal craving for 
alcohol. The vinous pessimism of old Omar finds a ready response in 
many a world-weary soul. Lauder Brunton remarked that the reason 
so many men took to drink after passing middle age was, that when 
they realized what fools they had been they got drunk to avoid going 
crazy. Which remark touched the center of a great truth. The 
realization by man of his own limitations and inefficiencies is not 
always accompanied by that abolition of self-conceit that prevents 
his expecting too much of himself. 

In general, the objections to alcohol as a stimulant are, then, that it 
is not a stimulant at all, but in all doses and in every sense a depress- 
ant, lessening the control of the nervous system, relaxing vascular 
tension, weakening the heart, increasing the production of heat, but 
lowering temperature by increasing the radiation from the cutaneous 
surface, and lowering the vital resistance. It interferes with the ac- 
tion of all the enzymes and only aids stomach digestion by an irrita- 
tion of the mucous membrane which is very often undesirable, and 
when advisable may be induced by less objectionable means. It par- 
alyzes the leucocytes and thus restrains them in combating invading 
microorganisms, rendering the assaults of the latter on the vital organ- 
ism more effective. It interferes with elimination by occupying the 
powers of the liver, as we have shown. 

With these general objectionable features it will be seen that alco- 
hol contravenes every principle of modern therapeutics, which looks 
to elimination of toxins, conservation of the vital forces, with modera- 
tion of disease processes, as three great indications for the exercise of 
the physician's art. This being the case, we have to ask, What are 
the advantages in its clinical application that may counterbalance so 
many and such weighty objectionable features? 

In shock, syncope, and heart failure we have imminent peril of 
death from sudden cerebral anemia. Alcohol further paralyzes the 
vasoconstrictors of the abdominal vessels and allows the blood to 
accumulate in their capacious recesses. Glonoin sends the blood to 
the brain, acts much more quickly than alcohol, and is here a life- 
saver. The effect of glonoin may be prolonged by the addition of 
atropine, whose power is developed more speedily when glonoin is 
simultaneously administered. The effect of this combination is 

S. Doc. 48, 61-1 10 



146 THE ALCOHOLIC PEOBLEM. . 

exactly what is needed; it is certain, and where time is so precious 
that a human life hangs on a few seconds' delay in getting one's 
remedy into action its almost instantaneous action is too precious to 
be lost. 

As a stimulant to counteract the depression caused by sedative 
poisons alcohol is dangerous as being itself a sedative poison. Strych- 
nine is here the remedy, with atropine and glonoin whenever cerebral 
anemia is a feature. In poisoning by the strychnine group the vascu- 
lar sedatives and analgesants offer remedies surer, quicker, and more 
effective than alcohol. 

The whisky treatment of snake bites is firmly implanted in the 
affections of the people; yet nothing in medicine is better proved 
than the fact that to the essential action of venom alcohol is syner- 
gistic. The danger here lies in paretic dilatation of the great abdomi- 
nal vessels, into which so much of the blood retreats that the brain 
is left destitute. Alcohol increases this vasomoter paresis and con- 
sequently adds to the danger. It has been shown that this vasomotor 
relaxation is exactly remedied by strychnine, and that the patient's 
life depends on giving enough strychnine to exactly balance the 
effects of the venom, even though the dose required is such as would 
certainly cause the patient's death if no venom were in his system. 
Here again we find the indication for glonoin and atropine, but none 
for alcohol. 

Typhoid fever : We have here presented one of the most remarkable 
contradictions in the history of clinical medicine, for in no disease 
has the use of alcohol been more urgently insisted upon than in 
this; nevertheless there is not an element of considerable danger in 
this malady which is not enhanced by this potent agent. Typhoid 
fever is a disease characterized in the first place by profound toxemia 
and consequent vital depression, and by a lack of that protective 
leucocytosis which is present in almost every other infectious malady. 

As we have seen, the toxemia is increased by the use of alcohol, 
which interferes with the natural elimination of toxins by occupying 
the forces of the liver for its own destruction or elimination. Besides 
that, it inhibits the action of the phagocytes, and thereby lessens 
the natural defenses of the body. Moreover, we do not have in this 
malady the excuse for the administration of alcohol which is present 
in such emergencies as snake bite, because we have no sense of 
apprehension to allay, no need for Dutch courage. The patient is 
already saturated with toxins, and there is a general vascular relaxa- 
tion throughout the body, which constitutes one of the principal 
dangers, leading to hypostatic congestion of the dependent parts, 
predisposing to a peculiarly perilous form of pneumonia. 

The indication is for support and elimination, and support more 
decided than could be secured from alcohol, even though it really 
were a stimulant. All the elements of danger are enhanced by the 
use of alcohol, and' it is a striking illustration of the truth that in no 
disease can a patient go so low and yet recover as in typhoid; that 
despite the almost universal use of alcohol the proportion of recoveries 
has been as large as it has. The modern treatment of this malady 
is, first, to keep the bowels clean and aseptic, and not leave poisonous 
fecal matter in contact with open intestinal ulcers. Elimination 
must be maintained; the vital forces must be sustained. In no 
malady is the problem of feeding presented with such difficulties or 



THE ALCOHOLIC PROBLEM. 147 

of more importance. It is best solved when alcohol is omitted ai*d 
foods given that can be absorbed from the stomach. 

Much of what we have just said applies to the administration of 
alcohol in pneumonia. Here again we have peculiar difficulties, and 
the added toxemia, relaxation of the circulation and enfeeblement of 
the heart, with the increased afflux of blood to the lungs, due to the 
action of alcohol, all add to the danger. The tendency to delirium in 
pneumonia is also increased by the use of alcohol. Altogether one is 
tempted to say that if any remedy is formally contraindicated here, it 
is alcohol. Great success has followed the treatment of this disease 
by lessening the bulk of the blood and moderating the pressure on the 
heart, which is overexcited and forcing too much blood into the suffer- 
ing lungs; by strengthening the heart when the slightest evidence of 
coming weakness is manifested: by regulating the vasomotor equilib- 
rium throughout the body and sustaining the vital forces ; while sub- 
tracting from the sum total of the symptoms of disease such as are due 
to depravity of the blood, from absorption of fecal matter retained in 
the bowel beyond the normal time. This applies to every febrile 
disease. In all of them alcohol can not but increase the danger, as 
interfering with elimination and relaxing vascular pressure, besides 
paralyzing the defensive phagocytes. 

The one advantage which comes from the increased radiation of 
heat from the body is easily secured by other remedies, which have 
not the same objections. 

Alcohol has also been urged in wasting diseases, occasioned by 
long suppuration, by impaired digestion, or by tuberculosis. In the 
first place we have effective remedies in calcium sulphide and other 
calcium salts, whose use stops microbic destructive action and pro- 
motes the reconstruction of the wasted tissues. By the administra- 
tion of nuclein we also have the means of restoring the number and 
increasing the activity of the leucocytes, which are being destroyed 
in vast numbers in the contest with the micro-organisms occasioning 
suppuration. These remedies directly increase the natural forces 
of the body, which alcohol as directly impairs. 

In the second class of wasting diseases, those due to digestive 
derangements, the indication is to restore digestion by the use of such 
remedies as are needed in each case, by a carefully regulated diet, and 
by the institution of a correct personal and domestic hygiene. Atony 
of the digestive apparatus may be relieved by the action of quavsin 
or other bitter tonics. A better supply of blood can be directed 
to the digestive apparatus by the use of iron and similar remedies. 
The blood can be freed from fecal contamination by proper attention 
to elimination and the regular evacuation of the bowels. 

In tuberculosis we have an acknowledged distinctly evil influence 
from alcohol with which to contend, and that is its tendency to favor 
the rryperplasia of connective tissue, with consequent atrophy of the 
cellular elements of the lung. This condition exists in all chronic 
pulmonary tuberculosis, and to a certain degree may be looked upon 
as a curative process. Nevertheless there is a tendency to the forma- 
tion of cicatricial tissue beyond the desirable limit, and~ this is favored 
by alcohol. Moreover, it has been the writer's constant experience 
that tuberculous patients, when placed upon any preparation con- 
taining alcohol, tend to rely upon it more and more as a nutriment, 
and to the extent to which they partake of alcohol the}^ consume 



148 THE ALCOHOLIC PROBLEM. 

less and less real food. Hence the improvement which is claimed by 
them from alcohol is illusory, the effects here mentioned being most 
undesirable in every way. The increased cutaneous radiation leads 
to increased wasting in some cases; in others the normal healthy 
tissues tend to be replaced by useless and unhealthy fat. 

Besides this, alcohol, as Metschnikoff has pointed out, exerts a 
deleterious influence upon the leucocytes, paralyzing these sturdy 
defenders of the human empire, and leaving the way clear for exten- 
sion of invading colonies of tubercle bacilli and other micro-organisms. 

The proper scientific treatment for tuberculosis would require a 
book. I simply point here to the importance of reenforcing leucocy- 
tosis by the use of nuclein, combating the numerous varieties of 
micro-organisms in the tuberculous tissues by saturating the body 
with the sulphides of arsenic and of lime, moderating the wasting 
fever by the use of the alkaloidal vasomotor regulators, purifying the 
blood and rendering it less suitable as a culture ground for the bacilli 
by preventing the absorption of fecal toxins ; carefully regulating the 
digestive apparatus and securing every possible advantage that a 
well-selected diet, pushed to the limit of the patient's digestive capac- 
ity, will afford; the minute treatment of symptoms as they arise, 
and that attention to hygienic matters which mean so much to every 
individual patient. 

Alcohol has been recommended as a remedy for persistent vomit- 
ing. Just why an irritant should be employed to sedate an already 
irritated stomach seems incomprehensible. The best remedy for 
such irritation is to keep the stomach absolutely empty until the 
irritation subsides. If a direct sedative is required, we have better 
remedies in cocaine, condurangin and bismuth, and in cases of 
severity small injections of morphine over the epigastrium. The 
action of these remedies is direct and unquestioned, and far more 
frequently and powerfully effective than alcohol in any shape could be. 

A popular and most common application of alcohol is to take it 
in the form of a hot drink in order to prevent "taking cold," when 
a person has been exposed to cold and wet. Here we have to deal 
with spasm of the cutaneous blood vessels, when the blood is pushed 
into the interior of the body, where the circulation is engorged and 
there is danger of local inflammation resulting. A glass of hot 
water with camphor, or spice, frequently relieves this condition, 
and accomplishes the desired result quite as well as does alcohol. 
It may not be so pleasant to the patient's palate, but we are not 
dealing with the craving for stimulants but with medical matters. 

Or the circulatory equilibrium may be more effectually restored, 
which is the actual indication for treatment, by the administration 
of aconitine and digitalin in combination, especially if taken in hot 
water, with a hot mustard foot bath or a general hot bath. Alcohol 
is unnecessary; it is not the best remedy, and it possesses a danger 
of its own, since we occasionally hear of patients falling dead from 
heart failure after a generous dose of alcohol taken under such con- 
ditions. 

The physician who by practice has rendered himself proficient in 
the study of abnormal vasomotor conditions and in the application 
of remedies which are directly instrumental in restoring the circula- 
tory balance, finds that charm in the practice of medicine which 
comes from one's knowing what he is doing and why he is doing it,- 



THE ALCOHOLIC PKOBLEM. 149 

and from the security he feels that the remedies he employs will exert 
exactly the influence he desires. We relax vasomotor spasm by the 
action of aconitine, veratrine, or gelseminine, either of which at the 
same time improves nutrition by letting in a freer supply of blood and 
favors elimination by opening widely the doors by which excreta 
escape from the body. At the same time we relieve the vasomotor 
paresis, which permits of hyperemia or congestion, by the adminis- 
tration of digitalin or strychnine; the first of which sustains and 
strengthens the heart; the second strengthens and sustains the res- 
piration, and by its influence over the nerve centers increases the 
control of the central nervous system and energizes every function 
of the human body. Our study of disease has taught us the impor- 
tance of keeping the alimentary canal in proper condition, and pre- 
venting the absorption of toxins from fecal matter and of regulating 
the diet and other points of personal hygiene to the patient's needs 
and circumstances. 

When one has accustomed himself to the study of the symptoms 
presenting in cases that come under his observation, and to fit 
thereto the remedial measures which are indicated in that particular 
case, from a study not of its dead anatomy but of its living physiology, 
he will inevitably find his applications of alcohol constantly decreasing 
until they arrive at the vanishing point. This has been the writer's 
experience, although he commenced the study of medicine with a firm 
conviction that alcohol was one of the prime necessities in medical 
practice, the conclusions herein stated being forced upon him by his 
clinical experience, against his will as it were, while he never allowed 
himself to be moved in the slightest degree by any other consideration 
than that of a determination to know and do what is best for his 
patients, in the way of promoting their restoration to health and 
prolonging their life. 

Stockman concluded from his experiments that moderate doses of 
alcohol did not influence the pulse rate or blood pressure. Under 
large doses of the drug the blood pressure falls. Since it is certain 
now that alcohol does not stimulate the brain but depresses it, it is 
now asserted that it is this sedative action of which the physician 
makes use. If this action is desirable, however, we have other means 
of producing it, much less objectionable than alcohol. Few physi- 
cians would think now of giving alcohol to a fever patient as a 
sedative, especially since when this poison adds its effect to those of 
the toxins already in the body, we may have a furious delirium as 
the result. 

Another claim recently put forward is that alcohol is beneficial 
because it retards cell action; but unfortunately the cell action which 
it impairs is that upon which we mainly depend for the continued 
existence of our patient; that is, the action of those cells which are 
engaged in eliminating the toxins whose collection in the body is the 
principal source of peril. 

Medical men cling with unexampled conservatism to their practices 
and opinions. McDonald, who writes recently in the British Medical 
Journal a defense of alcohol in medicine, says there still remain a 
few practitioners with whom it is an article of faith to treat all cases 
of pneumonia with copious libations of brandy, but they are a 
decadent minority. But there are many who hold, as McDonald 
does, that alcohol judiciously employed forms an important part in 



150 THE ALCOHOLIC PROBLEM. 

the treatment of this disease. We may look upon this also as a 
relic of that earlier belief represented by those just mentioned. 

For some time after discontinuing the use of alcohol in other cases, 
the writer continued to employ it with those who had been accus- 
tomed to its use, in the treatment of grave diseases; believing that 
it would be unwise to call upon such persons to reform while strug- 
gling with a malady which in itself might prove fatal. 

Here, however, I come in touch with the results obtained in 
hospitals, which discontinued absolutely and from the start the use 
of alcohol with patients suffering from delirium tremens. The fact 
that their results were better when alcohol was not used in any shape 
showed that even here alcohol was unnecessary. I therefore dis- 
continued the use of alcohol . even in habitues with pneumonia, 
typhoid fever, etc., and up to the present I can say frankly that 
I have had no reason to regret the change. 

I will sum the matter up by saying that personally I stand ready 
to use alcohol at any time when I believe it is to the best interest of 
my patients, but that I do not know a solitary use or a solitary 
case occurring in the widest range of medical practice in which 
alcohol is the best remedy that can be applied. 

In discussing this question I have left out absolutely all consider- 
ation of the moral effects and perils accruing from the use of alcohol, 
and have endeavored to look at the question simply from the stand- 
point of a physician who is solicitous to know what is the best treat- 
ment to be given to his patient in each condition of disease the 
doctor is called upon to treat. 

SUMMARY. 

(1) As a substitute, strychnine excels alcohol as a vital stimulant 
and an energizer of all the vital functions. 

(2) In shock, syncope, and other forms of cerebral anemia, the 
combination of glonoin and atropine is quicker, safer, and genuinely 
effective. 

(3) To quiet nervous apprehenison and enable the patient to look 
with equanimity upon his condition, without embarrassing the sur- 
geon by his dread of anesthetics, or of a proposed operation, an 
injection of morphine and hyoscine is much more effective than any 
quantity of alcohol that could be given, without adding to the danger 
of the condition as alcohol would certainly do. 

(4) As a stimulant of digestion alcohol is not equal to quassin or 
other simple bitters, with such artificial digestants as the case may 
require. 

(5) To prevent a cold or chill when wet, alcohol is not equal to a 
hot drink containing camphor or spice, or to a hot mustard footbath. 

(6) As a remed}^ for pain, nobody would think of using alcohol, 
excepting in the absence of morphine, hyoscine, ether, chloroform, 
atropine, camphor, cannabis, or any of the other direct analgesants. 

(7) In all forms of ' diarrhea and dysentery, it is now understood 
that the best treatment is to remove the cause of irritation and to 
soothe the irritated pneumogastric by the use of atropine, stopping 
microbin action in the alimentary canal by the use of intestinal anti- 
septics, and in case of dysentery soothing the irritation by single 
doses of emetine. There is no place for alcohol in this group of 



THE ALCOHOLIC PROBLEM. 151 

diseases in the hands of those who know how to use the active 
remedies of our profession. 

(8) As a hypnotic, alcohol may produce sleep by paralyzing the 
cerebral functions of the patient, a most undesirable and irrational 
method; or by momentarily equalizing the cerebral vascular pressure. 
In the latter case the same effect may be safely and quickly induced 
by administering a glass of hot water, or a few granules of aconitine, 
or of digitalin, according as the pulse tension needs to be lowered or 
elevated. Here again alcohol could only be used by those ignorant of 
the resources of modern medicine, and incapable of recognizing a 
pathologic condition and applying to it the remedy best calculated 
to restore normal, physiologic equilibrium. This applies to every 
application that could be devised for alcohol in the treatment of 
disease. 



THE GREAT TEMPERANCE PIONEERS IN THE MEDICAL 
PROFESSION AND THEIR WORK FOR THE LAST 
CENTURY. 



By Henry O. Marcy, A. M., M. D., LL. D., of Boston. 



It is often stated that the medical profession is responsible "in 
a very considerable degree for the drink habit and the use of narcotics. 
To this charge the physician may in a measure plead guilty. 

For the indefinite past, alcoholic preparations were believed to 
be, in the correct sense of the word, stimulants, although their 
narcotic effects were well known. When taken in large doses the 
direct and remote effects were accepted as injurious. 

There have even been exceptions to this rule, both in and out of 
the profession. 

In American medicine we find illustrious men who have given 
much time to scientific research work to show the effect of alcohol 
upon the human system. 

Dr. Benjamin Rush, of Philadelphia, perhaps the most noted 
physician of his time, prominent in every good work, in civil as well 
as professional life, a signer of the Declaration of Independence, was 
pronounced in his opinion as to the evil effects of alcohol, both as 
a beverage and as a medicine. In 1785 he published a pamphlet 
of 32 pages entitled "An Inquiry into the Effect of Ardent Spirits 
upon the Human Body and Mind, with an Account* of the Means of 
Preventing and of the Remedies for Curing Them." The entire 
article is worth a republication to-day. In an objective way he 
illustrates the effect of alcoholic drink by what he calls his moral 
and physical thermometer. I am indebted to Dr. Charles A. Ingra- 
ham, of Cambridge, N. Y., for an admirable historical address in 
which he refers to this article of Doctor Rush in a most complimentary 
way. He quotes the following as a curious anticipation of the 
modern gold cure as it took form in the fertile intellect of Doctor 
Rush. The association of the idea of ardent spirits, with a painful 
or disagreeable impression upon some part of the body, has sometimes 
cured the love of strong drink. This appeal to that operation of the 
human mind, which obliges it to associate ideas, accidentally or 
otherwise combined, for the cure of vice, is very ancient. It was 
resorted to by Moses when he compelled the children of Israel to 
drink the solution of the golden calf (which they had idolized) in 
water. This solution is made, as it most probably was, by means of 
what is called hepar sulpuris, was extremely bitter, and nauseous, and 
could never be recollected afterwards without bringing into equal 
detestation the sin which subjected them to the necessity of drink- 
ing it. 

152 






THE ALCOHOLIC PKOBLEM. 153 

Somewhat recently I had occasion to examine a little carefully 
into the practice of medicine during the early part of this century 
by the leaders of the profession in Philadelphia and Baltimore. I was 
surprised to find that Dr. H. G. Jameson, of Baltimore, emphasized 
the injury that occurred from the then common habit of a reduced 
regimen, the use of calomel and other cathartics, and that he totally 
forbade the use of all kinds of spirituous liquors by his patients. 
Referring to his frequent and continued observation as to their injuri- 
ous effects, he concludes by saying: "We must content ourselves, 
here insisting upon the facts, whatever may be thought of our 
theories." 

Unfortunately we gather far too little of contemporaneous opinion 
from the writers of text-books. One of the chief attractions of 
autobiographies are the pen pictures of the period. In this respect 
the autobiography of the late Dr. John C. Warren, of Boston, is of 
exceptional interest. It portrays the so-called " Washingtonian 
movement," and I can hardly do better than let the doctor tell his 
own story, since it is contemporaneous and graphic: 

In 1827 I joined the temperance society. My father, Dr. John Warren, was vice- 
president in 1813. 

In the same year I brought forward temperance resolutions in the Massachusetts 

Medical Society, which, after a violent opposition, particularly from Doctor T , 

were carried in a large meeting, with very few dissensions. The Reverend Doctors 
Channing, Gannett, etc", were the most active men at that time in the temperance 
cause. 

From that period I have followed up the temperance reformation. Mr. Alden Brad- 
ford, Mr. Pierpont, Mr. William Sullivan then gave in their aid. Soon after the 
orthodox or Calvinist clergy took up the matter; and, by a slow and regular movement, 
the country was more or less brought under the influence of temperance principles. 

In 1837 I went to England and conferred with the members of the British and For- 
eign Temperance Society, who were very cordial, and acted as chairman of a temper- 
ance meeting in the heart of the city of London. 

In the same year I had a conference with some members of the administration of 
King Louis Philippe in France, and laid before them statements showing the impor- 
tance and the progressive advance of the temperance reform. 

About the year 1840, in consequence of the formation of the Washingtonian societies, 
the Massachusetts Temperance Society — the oldest association — suspended its pro- 
ceedings, resuming their labors occasionally at such opportunities as occurred for mak- 
ing themselves useful. 

In 1848 we made publication of the documents of the Massachusetts Temperance 
Society, recording the principal facts in its history. At this time (February, 1849) 
no licenses to retail are allowed by law in Boston and the greater part of the State of 
Massachusetts. The same is true also of several other States. 

In the summer and autumn of 1849 I received letters from various parts of the coun- 
try, requesting my opinion of the necessity of alcohol in materia medica. After some 
months' reflection I wrote a short article for general distribution, showing that in many 
cases alcohol was not necessary; that it might be dispensed with in the preservation 
of infusions; that in many cases of tinctures a substitute might be found in a wine 
produced by the fermentation of a vegetable infusion with sugar. This preparation 
I had made, and tested its effect, first, by taking it myself; second, by giving it to 
others. The preparation turned out to be mild, agreeable, and efficient in its 
operation. « 

In the course of the past summer (1849) the famous apostle of temperance, Father 
Mathew, visited Boston, partly on the invitation of the Massachusetts Temperance 
Society, on my application. I met him at the Roxbury boundary, and saluted hi«i 
in a short speech, to which he replied. On the next day he drank tea at my house 
with Bishop Fitzpatrick, Mr. William Appleton, and others. Father Mathew em- 
ployed some months in traveling about this State to give the pledge to many thou- 
sands of individuals, and afterwards visited the southern cities. 



a This article was published and distributed by the Massachusetts State Temper- 
ance Society. 



154 THE ALCOHOLIC PKOBLEM. 

For the last seven or eight years I have ceased to give wine at the dinners of the 
Agricultural Society and at other dinners; also at evening parties of scientific persons 
and others. In the early part of my establishment it was thought necessary for every 
young housekeeper to lay in a stock of wine, which might grow old and ripen; and at 
that time I used two or three glasses of strong wine daily, and at some periods brandy 
and water, though not strong. When I began to take an interest in the temperance 
cause, in the year 1827, I gradually gave up the strong wines and took the weak French 
wines. On going to Europe in the year 1837, I was led, while in England, to resume 
them, though not with good effect. Two or three years after returning from Europe 
I gave up the use of it entirely, except as an article of the materia medica, and always 
found myself better without it, except in case of unusual debility, when, used as a 
medicine, it has sometimes appeared beneficial. 

On the whole, I can with confidence say that if I had never tasted wine my life 
would have been more healthy and longer and more comfortable. The efforts which 
I have been called to make in the temperance reformation, operating, as they have 
done, more extensively on the prosperity and happiness of the community, are a source 
of more satisfaction than any other labors. Probably my other occupations might 
have been as well or better performed by some one else; but perhaps it would have 
been difficult to find another person who would have been willing to undergo the oppo- 
sition, ridicule, labor, and expense in the cause of temperance. 

His biographer, Dr. Edward Warren, speaks of the customs of 
1820 to 1830 in Boston, and states it was the prevailing opinion 
that all mechanics, farmers, or operators of any kind should receive 
a regular supply of spirit. Among the higher classes, not only 
wine, but alcohol in some form was in daily use. The smoking 
punch bowl in winter or the ice pitcher in summer was no uncommon 
addition to the sideboard, which was generally' well supplied with 
every variety of spirit that the taste of each visitor could demand. 
Doctor Warren commenced his labors with great earnestness and 
with an interest which never abated through life. 

He prepared a series of resolutions which were heartily adopted. 
They declared that the use of ardent spirits is unhealthy and incon- 
sistent with a vigorous action of physical and mental power, and 
that the habitual use of wine is neither necessary nor salutary. 
Such resolutions were signed by most of the physicians in Boston, 
and published with a great beneficial effect. 

The number of drinking houses was diminished and laws were 
enacted which greatly lessened the sale of liquors. Doctor Warren 
published a small, neat volume entitled The Effects of Alcohol, 
which was widely distributed, under the supervision of the Massa- 
chusetts Temperance Society, which was founded in 1813. In a 
record of this society, under date of Jaunary 27, 1857, is the following: 

The council met at No. 2 Park street, Hon. Stephen Fairbanks in the chair. 

The treasurer announced the receipt of $2,000 from the administrators of the late 
Dr. John 0. Warren, the same to be safely invested, and the income thereof devoted 
to the dissemination of temperance publications. 

The limit of this paper permits reference to only one or two 
more of the great exponents of temperance among medical men. 

The late Dr. Henry D. Didama, of Syracuse, N. Y., furnishes a 
noteworthy example. Early in life he became convinced that alcohol 
in any form was not alone unnecessary as medicine, but its use was 
generally harmful. For more than fifty years he was a leader in the 
medical profession in the State of New York, the founder of the 
medical department of the University of Syracuse, and a wise and 
tactful teacher and practitioner. At his death he was president of 
the National Medical Temperance Association. He published many 
articles upon the effects of alcohol in both health and disease. Many 
thousands still hold him in tender, loving remembrance, and I am 



THE ALCOHOLIC PROBLEM. 155 

sure he felt that one of his most valuable s ervices rendered was from 
his study of the deleterious effects of alcohol upon man. He was 
so sweet and tactful in his teaching that he made few, if any, enemies 
in the presentation of the subject, and even those who differed 
from him in personal practice were willing to agree with him as to 
conclusions. 

Dr. N. S. Davis, of Chicago, is perhaps the most noteworthy 
example which the medical profession has furnished in the scientific 
teaching of the study of alcohol upon the human system. It has 
been my rare good fortune to have been a colaborer with him, as well 
as with Doctor Didama, in medicine for more than thirty years. 

I am indebted to Dr. I. N. Danforth's recent life history of Doctor 
Davis. His first publication upon the subject which I have been 
able to find was an address delivered on Christmas Day, 1854 — deliv- 
ered at the request of the students of Rush Medical College, entitled 
"On the effects of alcholic drinks on the human system and the 
duties of medical men in relation thereto." The last of his many 
publications upon the subject was in January, 1904, entitled, "Is 
alcoholic medication necessary? In other words, is alcohol, as it 
exists in various fermented and distilled liquors, a necessary remedy 
in the treatment of diseases of any kind or in any stage of their 
progress?" During all the years of his long and remarkable career 
he was an active worker in the temperance cause, and no one will 
ever know how many men he saved, from that terrible fate, the death 
of the drunkard. His hatred of alcohol was so intense that he was 
often called a "temperance crank," a "fanatic," a "faddist," and 
various other names which were intended to be opprobrious, but 
were in the highest degree complimentary. 

It must be remembered that in Doctor Davis's early days the 
use of alcoholic beverages was rather more common than the use of 
"aqua pura," nor was it regarded as improper or specially harmful. 
The minister, the lawyer, and the doctor each took his "toddy" 
without any idea of its impropriety, and in the country stores rum 
was sold as openly as and rather more frequently than "lamp oil" 
or molasses. When the merchant made out his yearly bill against 
his customers — professional men included — the item "1 gallon of 
rum" occurred about as often as any other item, and the farmer 
generally needed an extra 10 gallons to "get through haying." 

"It was several years after Doctor Davis had been a married man, 
or rather boy, and had graduated in medicine and become a le c ial 
voter, before the temperance cause acquired sufficient momentum to 
be respected or even felt. In those days it took some backbone 
for a young man to allow himself to be known as a l teetotaller,' as 
the early temperance advocates were contemptuously called, but our 
young doctor, standing almost alone, swerved not a hair's bread rh 
from his principle of absolute and uncompromising abstinence." 

From the very beginning of his medical practice to his last days 1 e 
absolutely prohibited the use of alcohol as a therapeutic agent, and not 
only that, out he talked against it to his patients, argued against it 
before various medical societies, and in his more public and popular 
addresses, and wrote against it in medical and secular periodicals far 
and wide. 

It would be impossible at this day to gather all of Doctor Davis's 
essays and addresses against the use of alcohol in any form ; either as 



156 THE ALCOHOLIC PROBLEM. 

a beverage or as a curative agent, but if this could be done the collec- 
tion would be about as formidable an array of antialcoholic literature 
as could be desired. Nor must it be forgotten that as long ago as he 
began practice, and in fact down to quite recent times, the use of 
alcohol in medical and surgical practice was not only very common, 
but its use was, by the majority of physicians, regarded as indis- 
pensable. 

When he came to Chicago, in October, 1849, he brought his tem- 
perance principles with him, and they certainly seemed to thrive in 
the uncongenial atmosphere of this their frontier city, with its cloud 
of frontier vices. Of course he preached temperance to the students 
of Rush Medical College, and later to the students of Chicago Medical 
College. A little later he delivered and published a lecture descriptive 
of some original experiments in relation to the effects of alcohol on 
respiration and animal heat. 

It is perhaps a fair and just statement to say that Doctor Davis 
came to be regarded as one of the best equipped men in the country 
in regard to the treatment, or more properly the curative manage- 
ment, of inebriety. He was chairman of the first finance committee 
of the Washingtonian Home Association ; he was also chairman of the 
executive committee from 1865 to 1881. During all these years he 
was almost invariably present at the stated meetings of the executive 
committee no matter how inclement the weather or how crowded he 
might be with professional cares. As one looks over the early records 
of the Washingtonian Home one is amazed at the constancy of his 
attendance at the meetings of the executive committee, as well as the 
meetings of special committees, which were frequently required for 
special duties, and of which "T>t. N. S. Davis" was pretty sure to be 
a member. 

It is well known to all medical men and to a great many of the laity 
that Doctor Davis was regarded as the father of the American Medical 
Association, now the most powerful and influential medical organiza- 
tion in the world. Of course his influence in the association was 
greater than that of any individual, and it is interesting to observe 
that he never missed an opportunity to urge his temperance doctrines 
upon this august body. Especially did he enforce his views as to the 
value — or rather harmfulness — of alcohol as a remedy for the treat- 
ment of disease in any form. In fact, he took the positive and rather 
radical ground that under no circumstances could alcoholic stimu- 
lants be regarded as necessary or even useful. The doctor presented 
several papers to the American Medical Association enforcing his 
views, all of which are published in official reports of the " Transac- 
tions" of the association. He also presented various papers based 
upon carefully conducted experiments before medical societies or 
other scientific bodies in various parts of the country, all converging 
on the single point of the absolutely toxic effects of alcohol, whether 
as a beverage or as a medicine. 

By way of securing a favorable hearing for his views and of assur- 
ing their perpetuation among medical men, he aroused the movement 
which resulted in the organization of the " American Medical Tem- 
perance Association," in 1890, and at the meeting in Detroit, in 
June, 1892, he delivered an address on the "Objects of the American 
Medical Temperance Association," in which the work of the associa- 
tion was admirably set forth. 



THE ALCOHOLIC PKOBLEM. 157 

The experiences of the illustrious men which I have referred to in 
this paper cover the period of American history from the establish- 
ment of our independence to the present. 

They had many colaborers of less note, but my object has been to 
show that the influence of the drink habit upon the nation has long 
been a subject of serious thoughtful scientific investigation. Such 
men live on in their influence into the indefinite future. 

Their mantles have fallen upon worthy successors. Others in 
their turn will continue in the good work, for the battle is not for 
the day, and in one form or another injurious effects of alcohol will 
probably continue for generations yet to come. 



THE PSYCHOLOGICAL BASIS OF INEBRIETY: ITS ^ETIO- 
LOGICAL AND SOCIAL FACTORS; REMEDIES. 



By Tom A. Williams, M. B., C. M., Edin., Washington, D. C. 



Why should an individual be compelled to periodically debauch 
himself with a narcotic, in spite of a repeated, firm intention to never 
again even taste the poison? The author's inquiry during a tem- 
porary residence at an inebriate's home in England showed that a 
great majority of the 50 inmates broke their resolves through inability 
to overcome the impulse. 

What is the nature of this impulse, what is its origin, why is it so 
irresistible; finally can it be overcome in those in whom it occurs, 
and how may its occurrence be prevented in others? If these ques- 
tions can be answered satisfactorily, there need be no prohibition 
remedy. 

That the longing is a state of feeling needs no argument. It is the 
call of the unsatisfied, of the miserable, of the depressed. It finds 
many answers, as that of Janet's patient (1) who solaced her unspeak- 
able anguish by dropping boiling water upon her naked feet; or as 
that other extreme case, the oriental mystics, the dervishes, who gash 
themselves with knives, although in both these and the Christian 
mystics who mortify the flesh in other wa^^s there is a definite reli- 
gious purpose in the deed which they use to assuage their yearning. 
Their emotional longing is essentially the same as that of the drunk- 
ard — both seek intoxication. But in the mystic the means are 
mainly psychic ; in the narcomanic they are a drug. 

This reeling of intolerable longing and consequent discontent is the 
unfortunate appanage of certain individuals; but in most cases it has 
arisen from ignorance, and has been fostered by mismanagement. 

The mother who seeks out every caprice of her child to satisfy it is 
laying the train for future explosions of uncontrolled impulse. The 
mother who neglects her child to the point of compelling him to seek 
amusement at all costs from any passerby, hence to discard every- 
thing which does not immediately please, is incurring many chances 
of her boy developing a habit of immediate satisfaction at all costs. 
Again, the parent who allows doctrinaire rigidity to alienate him 
from the sympathetic understanding of his child's innocent and 
harmless turbulence is driving him to seek elsewhere the modicum 
of solace which at least every child at times requires. A frequent 
outcome of this is the alternation of stoical self-suppression and 
outbursts of indulgence in what is believed to be wrong. 

Whether the indulgences of states of feeling find their accentuation 
in alcohol or whether they use some other aid is a mere accident of 
environment. This accidental nature of the response to longing is 
shown by the experiments of Pawlow with dogs (2). Thus, by asso- 

158 



THE ALCOHOLIC PROBLEM. 159 

ciation of ideas, ringing of a bell could determine gastric flow, which 
could be again inhibited by the showing of a whip; and in turn any 
impression could be substituted for these and produce pleasurable 
or painful emotions, as well as increase or decrease in the secretions. 

Longing may find satisfaction in religious searchings, taking the 
form of a desire for completeness and perfection. The brooding may 
eventuate in ecstasy, produced expressly and preceded by orison, 
so well described by Madame Guyon (21) and St. Theresa (22). An 
analogous phenomenon among the Wesley ans was called " the power." 
It was very puzzling to their founder, who, however, discouraged its 
manifestations. 

Though these phenomena often arose from, and were fortified by, 
suggestions from without in the nature of religious rites or personal 
exhortations, yet they responded to a need of certain organizations, 
and betrayed a lowered psychological tension proceeding from phys- 
ical nerve inadequacy. 

This state is shown also, and more familiarly, by worry, despond- 
ency, bad temper, lack of decision in small matters, morbid intro- 
spection, overconsciousness, increased susceptibility to temptation of 
appetite, which more often are at the root of the addictions to drugs 
for the purpose of uplifting the depressed feeling. 

In general, a habit reflex forms, and. the early indulgences are 
those which persist, but it must be remembered how much greater 
is a desire for spiritual sustenance and comfort when the stress of 
independent industrial life combines with the decline of youthful- 
ness. Hence the pathological indulgence of feeling in hurtful acts 
may be postponed quite late, although the pathological feelings had 
hitherto been there though restrained by self-respect, religion, the 
sake of decency, or fear of the criminal law. 

Of the feelings, it is preeminently true that appetite grows by 
what it feeds on. The indulgence of the sickly sentimentality of 
what Nietsche describes as " slave and woman morality," fostered 
by fond petting in childhood, is readily replaced later by the maud- 
lin self-satisfaction of the sot; the riotous self-indulgence of the 
untrammeled child, unconscious of the very real limitations set him 
by an arduous world, finds its counterpart in adult age in the illusory 
happiness of alcoholic vainglory. The poet Burns knew this in 
saying — 

Kings may be blessed, but Tam was glorious 
O'er a' the ills o' life victorious; 

as indeed he was where his immediate feelings were concerned. 

Psychological experiment shows how persons differ from day to day 
in mental capacity. Physiological experiment exhibits the difference 
in bodily secretions and in activity. Such oscillations are as true of 
the feelings, depending, as these do, upon bodily changes and mental 
impressions. Nearly all of us, then, must necessarily encounter phases 
during which our feeling is one of incapacity, even of inaptitude, dis- 
content, dislike of our surroundings, anxiety, etc. To support these 
unpleasant states a certain fortitude is required, unless one chooses to 
put an end to the state of feeling by some stimulus. The outcome of 
this course is the need for a very large stimulus to do away with a 
quite trifling feeling, for the power of resistance progressively de- 
creases by nonuse, especially when a ready satisfaction is within 



160 THE ALCOHOLIC PROBLEM. 

reach. The immediate satisfaction of desire at all cost is a habit 
which can be made or unmade at the will of the educator, and it is 
toward this factor that the prevention of inebriety must be directed. 

The remedy is the teaching of mothers to form healthy emotional 
habits in their children. The happy-go-lucky absolutism which so 
often asserts itself as capacity is sadly defective as such a guide for 
hesitating childhood. The mind, the emotions, and their manage- 
ment into a morality constitute the most difficult study and art. 
Woman's sphere is here, and is indeed a noble one, but instinctive 
motherhood has had its day. The women who aspire to bring up 
leaders of men in a nation which aims at future greatness must cease 
striving for vain things and no longer confine their attention to 
superficialities, but do as their grandmothers did, and buckle to, 
modestly, earnestly, thoroughly, to an understanding of that fasci- 
nating complexity — the heart and mind of the child. 

Even persons emotionally unstable may be readily taught to pro- 
vide against the extra load this might mean. Simple faith has in 
the past been efficacious in this respect, at least among the unin- 
structed mass. Endeavors have recently been made to restore this 
function to religion by claiming a combination with the science of 
the mind. I need not particularize, for in essence none of the meth- 
ods so far differ in principle from that employed by the priests and 
necromancers of what we now agree to be superstitions. In all, the 
means (3) consist of a rousing of the attention by rythmic sounds, 
a succession of images and, especially among the more barbaric, 
ordered movements, more or less varied spontaneously. In this 
respect, the ancient religions showed themselves empirically more 
efficacious, for the reinforcing effect of active movement upon our 
thought is now an established fact. Will is nothing more than the 
balance of the concomitant stresses toward movement, and peda- 
gogy has (4) taught us that present methods lack woefully that dyna- 
mogeny without which education is a mere name. In this respect, the 
modern world has been injuriously dominated by the armchair phi- 
losophers, who have neglected the facts of life, and, above all, the 
genetic factor. The notions of experimental science have not 3^et 
sufficiently penetrated the teaching of ethics. This has been left 
almost entirely in the hands of persons whose point of view is hope- 
lessly vitiated by the artificialities of outworn conceptions of the 
universe and of the mind of man, which are maintained by the tra- 
ditions of popular literature, academic philosophy, and ecclesiastical 
dogmata and ritual, whose nature precludes adjustment. 

The philosophers of the past have seen the need of and have tried 
to enunciate laws for the mastery of the passions and moods. Their 
efforts were nullified by too exclusive a reliance upon introspection 
and by their referring to extraneous agencies, such as ghosts and good 
and evil spirits, the more marked manifestations of disordered 
affectivity. It is to the study of this in our day by Cartesian methods 
that we owe the genetic point of view which I will briefly indicate. 

Moods and emotions, as Spencer (5) long ago showed, are the de- 
terminants of conduct. The direct power of idea and reason in modi- 
fying behavior has strict limits. However, the indirect effect is 
tremendous. Prevision, however, is the essential element of this 
control; and this prevision must occur before the formation of 
emotional habit. It is the very early years which form these habits. 



THE ALCOHOLIC PROBLEM. 161 

The perversion of infancy and childhood through the neglect by 
parents of the knowledge we have for guiding the disposition of a 
child is most reprehensible. The overthrow of the method of obe- 
dience to the arbitrary desires of a parent ignorant of the evolution 
of the child's mind has been followed by the equally obnoxious 
"laissez faire" methods, conspicuously shown in the United States, 
where the emotions and behavior at least are concerned. The 
abolition of obedience as such has enthroned the immediate impulse 
as the ruling factor. Our next advance must transfer from the world 
of commerce, finance, and even science to the field of social relation 
and ethics, and even religion, the powers civilized man has cultivated 
for receiving wide, deep, and subtle impressions, collating these 
accurately and judiciously, and of acting not upon the impulse of the 
moment, but as the result of the total impressions stored in his mind. 
Unless education in ethics becomes as kinetic when applied to 
normality as it now is with regard to business and the law it will 
continue sterile. To do this, we must order the consequences of 
our children's acts in conformity with their powers of observation 
and inference. The surest forerunner of unreasoning conduct in an 
adult is a childhood which is taught to act without understanding 
and to understand without acting. It is because of this that wisdom 
has fallen behind knowledge, and that where manners and morals 
are concerned people act indiscriminately, conventionally, im- 
pulsively, or indifferently, thanks to the apology for training they 
have received in childhood. It is significant that whereas they are 
not so trained in the arts and sciences, it is in these wherein so much 
progress has been made. 

The constant attempt to arrest the mental activities of the child 
by thwarting even his healthy impulses deprives him of initiative, and 
he becomes discontented unless entertained by others. This want of 
resourcefulness is a sure forerunner of ennui, of the loafing habit, of the 
need of something to pass the time, so prolific a source of drug habits. 
To prevent tins, method, as in the universities, is more important 
than results. Didactically memorized precepts have no meaning to 
the childish intelligence; whereas education by deeds is pregnant with 
results. The events upon which the child has to base his inductions 
must be carefully chosen by the parent to conform to the limits of his 
intelligence, and of course must not be at variance with natural law; 
for example, when he shows cruelty to an animal, there is no real 
efficacy in telling him he is a naughty boy, but a great deal in pre- 
senting him with a pet able to resent and produce discomfort. Again, 
if he shows fear of an animal, exhortation meets no stored memories 
upon which to bear; but the familiarity gained by fondling an animal 
which does not hurt soon substitutes a new emotional complex for 
that of fear. 

We expend millions of money, incalculable thought, and the health 
and lives of innumerable teachers upon the instruction of the intellect 
of the young by a curriculum artificially graded to meet the fancied 
needs of each period of childhood. The child is given meaningless 
problems in arithmetic to teach him to calculate; corollaries and 
inductions in mathematics to teach him to reason; dates and events 
in history and geographical details to teach him to remember; draw- 
ing, clay modeling, and manual training in general to teach him mus- 

S. Doc. 48, 61-1 11 



162 THE ALCOHOLIC PROBLEM. 

cular control. Something is taught of the arts of music, sculpture, 
and painting to teach him aesthetic appreciation, and even the sciences 
are touched upon to give him a notion of the world in which we live. 
But the object of all these, the first, intermediate, and last art, that of 
living in relation to others, is taught only in the most haphazard or 
arbitrary way or entirely neglected. Is it not reasonable, therefore, 
to demand for this at least the beginning of a graded curriculum, in 
which examples must be worked out by the student and in which he 
is taught u rule" by " practice V The ethics which is taught in the 
rule of thumb way of the average family is still that of rudimentary 
survivals. It is conspicuous for its poverty in such criteria of modern 
civilization as justice, liberty, courtesy, altruistic sympathy. The 
natural good impulses of the child are even artificially checked and 
twisted; his reasoning from cause to effect where conduct is concerned 
is neglected or obstructed ; he is thus confused, and finally discouragec 
into sadness or indifference, and is bred into a despondent or happy- 
go-lucky man, ethically speaking. Even if knowledge and freedom 
are ultimately attained, it remains difficult to throw off the affective 
accompaniments of conduct first practiced under such brutish aus- 
pices (6). 

The responsibility for the different attitude which the child observes 
in his parents toward moral questions as against others must be laid 
to the door of religion; for the sacrosanct connotations of super- 
naturalism which pervaded morality in days of ignorance and repres- 
sion have still survived, on account of the want of its scientific study 
and practice. On the one hand, we find a perpetuation into adult 
mental life of the helplessness and irrationality of the child; and at 
the other extreme is taught the inherent damnableness of human 
nature unless justified by faith. Need one insist upon the effect of 
either of these artificial attitudes, upon the cultivation of the power of 
observation, inference, and of reasoning in general ? 

Its effect upon the sentiments has been even worse ; for in the child 
of careless or indifferent mind these qualities have been perpetuated 
by the attenuation of their results into a state of happy expectancy 
that the Lord will take care of his own. The second extreme will fall 
most heavily upon the child who is inclined toward overconscientious- 
ness. The neurologist almost daily is presented with examples where 
this morbid trend has been cultivated to excess by the religious atmos- 
phere legated by the apostle of Geneva. 

As Tollner said, "Play of whatever sort should be forbidden in all 
evangelical schools;" but Frobel has said, "Play is not trivial. It is 
highly serious and of deep significance. The play instinct affords the 
teacher and parent a ready opportunity of training the child into right 
ways of living." 

Now, the cultivation of either the happy-go-lucky disposition or that 
of hyperconscientiousness is bad for that intellectual and affective 
poise which is the best safeguard against the psychological state favor- 
ing inebriety. A disposition toward carelessness is fortified by the 
constant leaning upon others ; the scrupulous disposition is fostered by 
misplaced reliance upon the so-called intellectual determinants of 
conduct. To the child these are meaningless, because they are mere 
symbols of something he can not understand, owing to want of motor 
experience. That which makes a concept effective is its motor ele- 
ment; without this it is quite incomplete. It might nearly be said 



THE ALCOHOLIC PROBLEM. 163 

that an idea which has never been kinetic is impossible — that, indeed, 
the notion is not in consciousness ; all that is there is the simulacrum 
constituted by the verbal image. A familiar example is the child's 
" chart in Heaven," which shows how little he was conscious of the 
real meaning of the Lord's prayer. 

The truth of this is implied in the old proverb, " Example is better 
than precept," but the implication depends upon the fact that this 
example can be understood and hence rendered kinetic by imitation, 
while precept conveys comparatively small meaning. Consider the 
concept of a dog. The real properties of this creature come only from 
personal contact. The child by mere gazing and hearing can gain no 
knowledge of the dog's weight, roughness in gamboling, painfulness of 
claws and teeth, the difference between long hair and short, and so on. 

The kinetic element is more important still in the acquisition of an 
art, such as the working of wood or metal. "On devient forgeron en 
forgeant," and only so; but these experiences must not be forced at 
undue age, or the painfulness of their acquisition will bring disgust 
instead of pleasure. As accomplishment is learned, the kinesthetic 
element tends to fall more and more into the background, and to be 
represented visually and auditorily; but it is nevertheless present, and 
once more emerges during states of mental dissolution. It is the real 
basis of knowledge, and the neural stresses entailed by its inhibition 
from activity have important functions in the associational processes. 
Examples abound. Isaac Newton was at the foot of his grade at 12. 
He showed neither ability nor industry. Charles Darwin was not at 
all a studious boy. He writes : 

To my deep mortification, my father once said to me, "You care for nothing but 
shooting, dogs, and rat catching." 

Rosa Bonheur in her eleventh year generally contrived to avoid the 
schoolroom, and spent most of her time in the woods. When placed 
with a seamstress in order to learn to sew, she implored her father to 
take her away, which he did, and, much perplexed, left her entirely to 
herself; and Rosa, full of unacknowledged remorse for her incapacity 
and uselessness, sought refuge from her uncomfortable thoughts in his 
studio, where she learned her art as a solace, in play. 

A vast majority of parents and teachers do not appreciate the tre- 
mendous possibility of character building through play, and they try 
to subdue it in the child, thinking ii is something he should overcome, 
forgetting that when the time comes it will pass out of his life, and it 
will do so as naturally and readily as the tail of the tadpole is absorbed 
when there is need of the legs of the frog. The hilarious enthusiasm of 
childhood and youth will in time develop into the eager earnestness of 
the business man, the soldier, etc. As said Stanley Hall (7) : 

There is a sense in which all good conduct and morality may be defined as right 
muscle habits. As these grow weak and flabby, the chasm between knowing the right 
and doing it yawns wide and deep. 

As F. W. Robertson said: 

Doing is the best organ of knowing. 

This must become the dominant note in the pulpit itself as soon as 
the preacher seeks to know what the soul really is. 

That this is being realized is shown by the playgrounds movement, 
which in Germany are used as developer of the inventive and creative 
instincts, and for the growth of muscle, mind, and morals. In Eng- 



164 THE ALCOHOLIC PROBLEM. 

land this is done in the national games, which are a part of the cur- 
riculum in the better secondary schools. In these games the masters 
themselves not only supervise but participate, and in this way 
encourage fortitude and the spirit of fair play, and restrain, or at least 
guide, the exuberance and natural brutality of the boy. As a matter 
of fact, phylogeny shows us that the most valuable lessons of life 
should be taught in play. For instance, in the gambols of young rab- 
bits it is the mother who teaches them to enter and leave their bur- 
rows quickly. In the menagerie one may see the parent lion or tiger 
teaching its cub to leap from ambush. W. J. Long believes that the 
old beavers set the young ones to work building dams in summer so 
that they will have learned to do so when required, and all this is done 
in and as play. 

But educators, unfortunately, think that they have discovered a 
better way than the natural one; and our little children were, and still 
are, forced, against all the instincts of life, away from their play into 
schools, where in many cases play is rarely permitted. As a result, 
they are suffering from arrested development of the will, as well as of 
the emotions and the intellect. No wonder Frobel insisted — 

Wouldst thou lead the child in this matter, observe him. He will shew thee what 
to do. 

The child in a palatial nursery may lead a life even less desirable 
than that of those in shops and factories. He too may miss the stages 
of distinction only possible with constant reactions to healthy environ- 
ment. Even though not stunted physically, he is certain to be so 
mentally and morally; for as James has said: 

The boy who lives alone at the age of games and sports will usually shrink in later 
life from the effort of undergoing that which in youth would have been a delight. 

And so with traits of character, they must become reflexes in child- 
hood and youth, or the opportunity for their development will have 
passed. Otherwise we shall crush out characteristics upon which 
future strength depends, and force the growth of untimely virtues, 
which will never become mature. Take pugnacity for instance; it is 
generally suppressed in modern education, which forgets that the 
"good man is not the man who never fights, but rather the one who 
does, and fights for the right and in defense of the downtrodden." 
Similar arguments may be used with regard to selfishness, anger, 
cruelty, rude humor, venturesomeness, and other so-called evils. 
As a matter of fact, the boy who can not play, if he has had the oppor- 
tunity, is not capable of work; for both.work and play are merely the 
use of the surplus of energy after breathing, digestion, and circulation 
of the blood have been accomplished. 

The superiority of play as against work in the development of a 
child's character is due to the interest it gives. This stimulates effort, 
without which development will be imperfect. Indeed activity made 
without effort conduces to bad habits of action, slovenliness, and lack 
of will power — the want of forcefulness. 

Regarding altruism, play is again the best developer. The small 
child can not but be selfish; he can not see the need of cooperation. 
Group games will gradually teach this. For instance, little boys have 
no acknowledged captain; but later, the efforts to play well and for 
the team to win make necessary the subordination of certain indi- 
viduals for the good of the whole, and so first a temporary and later a 



THE ALCOHOLIC PROBLEM. 165 

permanent captain must be selected. From this develops a respect 
for law and order, the will to submit to discipline and amenabilit}" to 
the results of its infraction. The unselfishness thus derived is an 
active force in the future man's life; it is kinetic. Hence we may no 
longer say that knowledge alone is power; and we may say, again with 
Frobel: 

A comparison of the relative gains through play of the mental and physical powers 
would scarcely yield the palm to the body. Justice is taught, and moderation, self- 
control, truthfulness, loyalty, brotherly love, courage, perseverence, prudence, 
together with the severe elimination of indolent indulgence. 

Premature attention to the inhibition of motor activities in the 
development of man prevents the development of the psychological 
systems, without which capacity can not be attained. Resolution 
becomes permanently "sicklied o'er with the pale cast of thought;" 
and, moreover, not only are the activities incomplete, but those which 
develop are incommoded by the constant fear brought by an over- 
active conscience. As James (8) has asked: 

How can social intercourse occur in the sea of responsibilities and inhibitions due 
to the self-centered horror of saying something too trivial and obvious or insincere or 
unworthy of the company or inadequate to the occasion? 

Now, the tremendous friction of a life of restraint upon normal 
activity causes nervous exhaustion, and this feeling is so painful that 
one readily flies to what removes it. Hence inebriety. 

On the other hand, there is danger in the noncultivation of inhibi- 
tion, for impulsiveness then rules, and this meets with innumerable 
inducements to intemperance of all kinds. But its cultivation must 
not conflict with ontogeny, and above all must be kinetic. 

It is from these two extreme types that are mainly recruited the 
intemperate. 

As may be readily perceived, the treatment differs radically in the 
two types, the latter of which may be called the hysterical, the 
former the psychasthenic. The words are used in the sense given 
them by the modern French psychoneurologists, represented, respec- 
tively, by the schools of Babinski (9) and Pierre Janet (10). A few 
words must be said of the two diseased conditions connoted by these 
terms. As I have remarked elsewhere (11), "the very important 
diagnosis between hysteria and psychasthenia depends upon the 
following: First, as to fixed ideas, their duration in hysteria tends 
to be long, for though they are easily buried and forgotten, they are 
resuscitated with great ease and infallibility; whereas in the psychas- 
thenic the fixed ideas are very mobile, but keep recurring voluntarily, 
and indeed become cherished parts of the individual, and are far 
more difficult to eradicate than those of the hysteric. Secondly, 
hysterical ideas are evoked by well-defined and not numerous asso- 
ciations, "suggestions;" in the psychasthenic they are often evoked 
by apparently irrelevant associations, which are searched for b}^ the 
patient; thus the points de repere are very numerous, can not be 
predicted with certainty, and are often mere excuses for crises of 
rumination or tic. Thirdly, in the hysteric the ideas tend to become 
kinetical, whereas the psychasthenics constant state of uncertainty 
causes him to oscillate between 'I would' and 'I would not.' Inhibi- 
tion is too strong to allow an act, but not strong enough to dismiss 
the obsession." 



166 THE ALCOHOLIC PEOBLEM. 

Psychasthenics are naturally fitful eaters, and every heavy meal 
will cause an intoxicative metabolic upset, which will produce the 
conditions for an exacerbation of psychasthenia, which in turn readily 
induces inebriety. If in the treatment attention is drawn to this, 
food and appetite scruples may be produced and hence undernutrition, 
and even hypochondria. Therefore it is best to dose the repasts while 
training the judgment, and not to tell the patient until his critical 
impersonality is better cultivated. 

Another cause of psychic perturbations which call for extraneous 
stimulus is illustrated by the case (12) of the woman who had been 
prescribed 3 grains of caffeine each day. After eight months of 
frequent attacks of angoisse she gave it up, whereupon the attack 
ceased. She, however, resumed the drug; but the attacks recurred 
and she relapsed again and again, until finally she ceased the caffeine. 
When one remembers that this is only the quantity contained in one 
and a half cups of coffee of average size and strength, or in about 
three cups of tea, a frequent and insidious cause of nervous depression 
is strikingly revealed. 

Psychasthenic needs and insufficiencies may be imitated by sug- 
gestion (13); e. g., when vacuity of mind occurs, attention naturally 
concentrates on the desirability of something to remove it. The first 
thing thought of constitutes the suggestion. It may be mischief, as 
in a crowd of hooligans and schoolboys ; it may be an impulsion to 
move, as of horses in a field, the rapid contagiousness of such move- 
ments being there well seen. The stampeding of military horses 
is a well-known example. Accustomedness and training turn these 
vacuous trends toward work or profitable amusement like the arts 
of music, painting, and sculpture, and other interests. Hence the 
value to most people of a hobby. The vacuousness, boredom, is 
worse at night in some persons. Suspicions may form; and such 
ideas, easy during dejection, have often been reenforced by the 
superstition that they are instinctive, e. g., it has been believed that 
Mohammedans detest pork by nature, whereas they really do so 
from suggestion and imitation in childhood. Similarly, fear of the 
dark is inculcated, and not merely instinctive as the study of paedology 
shows. A striking instance has recently come to my attention where 
entire fearlessness in the dark marks the three girls of a mother whose 
life was a burden to her on account of the terrors learned from super- 
stitious negroes, although she no longer believed them. 

It is essential to supply occupation of vacant moments for sug- 
gestible persons failing strength of psychic constitution or its substi- 
tute in philosophy or moral training. 

Again, intemperance in eating (due to bad childhood habits, eating 
being a very strong instinct then) lowers feeling of wellness; and 
this leads to want of stimulus; hence desire for an uplift, such as 
alcohol when used to it, tobacco, etc. 

Another cause conducing to a psychic state favoring inebriety is 
the impelling, by an ambitious or art loving desire, beyond one's 
endurance, which entails consequent loss of sleep, hasty meals, 
unsettledness, and anxiety often justified by business oscillations. 
I recollect a letter sorter who broke down on account of the added 
stress caused when he wrote novels, and poor things they were. 
Foolish ambitions are most rife in suggestible people, whose critical 
power is low. They make misfits; and constitute the windbags so 



THE ALCOHOLIC PROBLEM. 167 

rife in public and official life. These are the penalty of all govern- 
ment. Lack of abilit3 T must be compensated by extra work. Many 
a broken down professional man is a spoiled barber or plowman. 
The effects of these extra loads depress the psyche, and lead to desire 
for stimulus, and hence to inebriety. ■ 

A form of addictive tendency, unfortunately too common, is that 
induced by the reaction of the patient against some disappointment, 
disgrace, or other psychic trauma. In its essence this is what psy- 
chologists call a defense reaction, and further analyzed is one of the 
varieties of what Dupre (14) has termed mythomania. The appetite 
for distinction, the dislike of neglect, determined to be fed and naving 
no means for satisfaction through exhibition of talent or capacity 
to perform in some useful way or from indolence or cowardice of 
disposition, resorts to the extortion of sympathy by its perseverance 
in a suffering in which the patient indeed comes to believe. 

Sympathy and praise removes depression or vacuity of mind, 
titillates the psyche. A child who has learned to lean upon others 
is a candidate for false neurasthenia of this type when later in life 
some business or social project miscarries. When a person is ruined 
or slighted or when ambition fails, neurasthenia is often diagnosticated 
and a rest cure imposed or drink flows to terminate the suffering. 

A remarkable case has just come to the writer's attention (15). 
It was that of a naval yeoman, who, after rapid promotion, of which 
he had reason to be proud, utterly broke down on account of the 
exactions and irritability of a new commander whom he could not 
please. His state of health eventuated in his desertion, although 
this stigma w T as later removed from his record. His symptoms were 
morosity and loss of interest and stamina, impotence, and over- 
powering desire to get away from his distressing environment and 
to go to his mother. He also seriously thought of commiting suicide. 
He became suspicious to the point of believing that the object of his 
persecution was to promote over his head his clerk, who had been 
longer in the service and was more efficient than himself, though too 
unreliable for the chief post. As soon as he felt that he was in an 
asylum and free from the risk of having to return to an environment 
he could not stand he began to improve and recovered within three 
months. All the time he was glad to believe himself insane; and 
indeed while under treatment before going to the asylum had run 
away from home with the vague idea of finding employment. 
Although well in other respects, he still interpreted his experience 
as an attempt by the commander to supplant him. 

The state of mind from which this man suffered is very common 
as a consequence of failures of ambition, disgrace in business, politics, 
etc. The reaction depends upon the ps3 T chic make-up of the patient. 
The mental alienation by no means invariably tends toward suicide. 
It may take the form of religious remorse, and very commonly con- 
sists of resort to so-called stimulants; in such a state drunkenness 
is easily acquired. Early schooling in buoyancy under adverse 
contingencies not only tends to prevent the development of the 
paranoid state shown in this patient, but makes the reaction to the 
paranoid syndrome less unhealthy than suicide, drunkenness, or 
even general suspiciousness. 

A fourth type of inebriate differs from the three foregoing in not 
being a psychopathic; it is represented by the man who drinks to 



16S THE ALCOHOLIC PROBLEM. 

excess (without very obvious detriment to his efficiency) on account 
of the habits pertaining to his environment. A drayman, commercial 
traveler, or our "three bottle" ancestors are examples of this type. 
Such people have not taken to alcohol on account of mental depression 
or through want of will or even from pleasures of the palate or general 
feeling. They are not inebriates until their will is destroyed by 
years of intoxication; their psychic degeneracy is acquired, not 
inherent. The number of this class is rapidly diminishing with the 
spread of knowledge of hygiene with regard to intoxicants. To the 
intemperate advocates of the temperance movement is perhaps due 
some credit for this improvement; their agitation has at least kept 
the subject in the foreground, and thus directed toward it the scientilic 
research of which our present knowledge is the fruit. An example 
is that of the poor lad who consulted me for nervous breakdown due 
to alcohol which he had first learned to take because at the age of 
13 he looked upon the big boys who did so as heroes. 

I have purposely refrained from speaking of the psychological 
effects of alcohol; this problem of physiological experiment has been 
clearly solved by the researches of Horsley (16) and of Kraepelin 
and his followers (17). There is no longer any dispute about alcohol's 
paralyzing effect upon neuronic activity as measured psychometric- 
ally. The more complex is the neural process the more detrimental 
is the intoxicant. 

But the problem we have to face now is the means of preventing 
these injurious effects, by studying the factors which lead individuals 
to incur them. I am well aware that the psychological factor is 
only one of these; and I have accordingly emphasized its relation to 
the pedagogical. Economists, sociologists, criminologists, and legis- 
lators may occupy themselves with the various factors of the prob- 
lems which pertain to their respective sciences; but without a precise 
determination of that psychological character of the individual 
against which they must direct their efforts, their labors must be 
sterile, even if not injurious. Hence it is upon the student of morbid 
psychology that each and all must found their procedures if they 
wish to build rather on rock than on sand and to hew a step more in 
the advance of humanity toward the perfection it seeks. 

Again, when a tendency to inebriety recurs, when founded upon 
one of the psychic perturbations indicated, it is to the student of 
morbid psychology that recourse must be had. The developments 
of psychic therapy in our day are greater than I can even attempt 
to outline, so complex are their ramifications. Suffice it to say that 
in them we find an answer to the despairing query of Hambt, "But 
who can minister to a mind diseased?" 

REFERENCES. 

3. Janet. Les Oscillations du niveau mental. Congres international de Rome, 
1904. 

2. Pawlow. Huxley Lecture. British Medical Journal, 1906. 

3. Leuba. American Journal of Religious Psychology, 1906. 

4. O'Shea. Dynamic Factors in Education, London and New York, 1906. 

5. Spencer. Principles of Psychology. 

6. Friedmann and Gierlich. Studies of Paranoia, Translated in Nervous and 
Mental Monographs, 1908. 

7. Stanley Hall. Adolescence, New York, 1904. 

8. James. Essays, 1904. 



THE ALCOHOLIC PROBLEM. 169 

9. Babinski. Ma Conception de I'hysterie. Paris, 1906. Williams. Status of 
Hysteria. New York Medical Journal, January 9, 1908. 

10. Raymond et Janet. Les Obsessions et la psychasthenic. Paris, 1903. 

11. Williams. International Clinics. Vol. iii, 1903. Also The Trend of the 
Clinician's Concept of Hysteria. Boston Medical and Surgical Journal, March 25, 

12. Archives de medecine provinciale, 1899. 

13. Williams. Differential Diagnosis Between Neurasthenia and some Affections 
of the Nervous System for which it is often Mistaken. Archives of Diagnosis, 1909. 
Also The Importance of Distinguishing Types among the Psvchoneuroses Journal 
of Abnormal Psychology, March- April, 1909. See also Spencer. Education. Phys- 
ical, Intellectual, Moral. Gilman. Concerning Children, New York Gould Will 
Women Help? Swift, Mind in the Making. New York, 1908. 

14. Dupres. La Mythomanie. Paris, 1905. 

15. White. Washington Society of Nervous and Mental Disease. 1908. 

16. Horsley. Alcohol. London, 1906. 

17. Kraepelin. Arbeiten, 1889. 

21. Moyen court et facile de faire oraison, 

22. Le Chateau interieur. 



THE TURKISH BATHS IN INEBRIETY. 



By Charles H. Shepard, M. D., 81 Columbia Heights, Brooklyn, N. Y. 



It is commendable for us to review the past and thereby gain 
wisdom and strength to meet the new problems of the day. That, if 
nothing more, justifies our gathering here. We feel that our cause is 
a holy one — the enlightenment of the community as to the real effect 
of all narcotics on the living body. This knowledge will result in the 
total abolition of the saloon and the disuse of alcohol in all edible or 
medical products, for why should intelligent manhood continually 
swallow disease and destruction as his daily food and drink? 

We may well rejoice in the progress that has been made, but by no 
means have we reached the limit. There is one eternal progress that 
is continually carrying us along, and still greater victories are in 
sight. Theie is yet to be a greater temperance, wherein all narcotics 
shall be inhibited and a higher life of freedom from its complexities 
shall obtain. 

Inebriety is such a dominating fact and so fruitful of ruin to 
thousands in our community that the study of its inception and the 
means of its amelioration are forced upon every humanitarian. 
Prominent, if not the first of its causes, is the financial one, and 
though philosophers have given us many theories concerning the 
progress of poverty, it still remains with us and is likely to con- 
tinue until, in some future time, society shall deal with it in the 
broad, generous spirit of cooperation. A few years ago an extensive 
investigation was made in England, under the auspices of Lady 
Somerset, to ascertain the causes of intemperance, and the conclusion 
arrived at was that 86 per cent of the whole number were directly 
traceable to poverty or financial causes, and the great cause of this 
86 per cent was summed up in one word, "competition." In this 
country the investigation of Prof. J. J. McCook showed that the 
large increase of vagabondage, including tramps, in the years 1874 
and 1894, was directly traceable to the panics of 1873 and 1893. 
Prof. F. S. Nitti, in Economic Journal, says: 

The working classes, swayed by instinct, rush eagerly to stimulants, and the work- 
man is inclined toward their use in proportion to the poverty of his food budget. 

Intemperance as a cause of poverty has been greatly overworked, 
both by temperance reformers and by optimistic economists. It is a 
great cause, but it is not at all certain that it is the chief cause. A 
medical journal says: 

When medical men begin to study the cause and cure of poverty and its dreadful 
effects upon God's creatures, the sick and weary at heart may hope for a millennium. 
Poverty is a disease of present social conditions and needs our thought as much as 
the oncoming of a plague of cholera. 

Another cause pf the prevalence of inebriety arises from the popular 
confidence in alcoholic drinks and other narcotics, and this confidence 

170 



THE ALCOHOLIC PROBLEM. 171 

is largely bolstered up by physicians who freely use narcotics. With 
good reason ma}^ the layman say that if alcohol is valuable as a medi- 
cine it necessarily must have some virtue as a beverage. The testi- 
mony of science is daily refuting this theoiy, and the misery and 
disease brought about by its use is constantly emphasizing this truth. 

When we realize the great importance of the fact that alcoholism is 
not only a curable but a preventable disease, we will not hesitate at 
any effort to alleviate the condition. 

The central idea we wish to present now for your consideration is 
a means of prevention as well as cure, and this may be stated in a few 
words as the establishment of a new habit among our people — that is, 
the habit of the bath. From earliest times bathing has been utilized 
as an important agency in treating the sick, and its efficacy as a pre- 
ventive of disease, as well as a remedy, is daily evidenced by unpar- 
alleled success when administered by competent hands. New reme- 
dies are vaunted for a short or long time, as the case may be, only to 
fall into quiet desuetude; but baths have ever remained to bless and 
benefit us by their revivifying influence. There are many varieties of 
baths, some good and others very good, but the most complete form 
of all is ordinarily called the "Turkish" bath. One who has not 
studied this subject can scarcely realize the beauty and magnitude, as 
well as the utility, which this form of bathing attained during the 
Augustan period of the Roman Empire. 

Physicians of every school, as well as the common sense of mankind, 
agree that cleanliness is the very first requisite to health. If a man's 
blood is pure, he is not only less liable to disease, but when overtaken 
by such calamity his recovery is more quickly assured. Disease comes 
largely from impurity of the blood, which is the result of improper liv- 
ing, and this condition is more promptly relieved by the sweating bath 
than by any other process. 

Can we not teach the people to give more time to rest and recupera- 
tion and to a study of the laws of health, with less devotion to stimu- 
lation? If it is wished to place the inebriate in the condition most 
favorable for cure, it is important that there should be institutions 
created for that purpose with desirable surroundings, as well as con- 
trol over the patient. The model institution is yet to be built, by and 
under control of the State, wherein the hot-air bath shall hold a pre- 
eminent position, where narcotics shall be entirely disallowed, for it 
is not much improvement on inebriation to have one's system sat- 
urated and senses blinded by narcotism. 

It was not until such self-sacrificing men as Doctor Turner, Doctor 
Parrish, Doctor Mason, Doctor Crothers, and a few others made plain 
to the community the true standing of the inebriate that a right 
appreciation of such cases was obtained. They showed that this 
disease was one to be treated on the same general principles as other 
disease. Nor should the noble, self-sacrificing work of Doctor Day 
be forgotten. He, with others, have passed on, but their work remains 
to us as a guide and a blessing. 

Dr. J. Edward Turner was a man born over fifty years ahead of his 
time, with a natural overflowing sympathy for his fellow-man when- 
ever he found him in distress. He gave his life to the work of benefit- 
ing the inebriate. We are constantly acquiring proof of the soundness 
of his advanced ideas as they are daily put to a practical test. His 
name heads the list of workers in this field, as he built the first inebriate 
asylum in the world. The corner stone, after an unparalleled amount 



172 THE ALCOHOLIC PEOBLEM. 

of work on his part, was laid in the year 1858, at Binghamton, N. Y., 
and the institution, which was opened for patients in 1863, was car- 
ried on under his administration for three years with great success. 
Many who were his patients then have since been useful and honored 
members of society. The history of that institution, after he was 
forced to leave it, shows how the most beneficent enterprise may be 
wrecked by bad management. 

A prominent feature in Doctor Turner's plan of treatment made it 
necessary to isolate the patient from the possibility of obtaining 
alcohol in any form, and to continue this exclusion long enough to 
make a complete cure, the time varying in different cases according 
to the condition of the patient. It has been demonstrated over and 
over again that unless entire exclusion can be obtained the treat- 
ment requires repetition. There are many reasons why an institution 
is essential for the care of inebriety as well as for many other diseases. 
The appliances for treatment are more complete than can be possible 
in the individual home; the supervision of the physician is direct and 
constant, and therefore the attention is more prompt; the surround- 
ings of the patient as to sanitation, diet, etc., can be better regulated, 
and the uniformity of life, as well as treatment, all conduce to a 
speedy recovery. 

When we have secured an institution, or at least placed the patient 
out of the reach of narcotics, then comes the restoration of the func- 
tions of the body to their normal working condition. It is well known 
that the action of alcohol, as well as narcotics generally, retards the 
waste of tissue, and some have imagined this to be an advantage, but, 
on the contrary, the system, by the free use of these agents, is often 
loaded, as it were, to the brim, and is ready at any moment to be 
discharged like a cannon at the touch of a match, and for this reason 
they are more dangerous. Notice how many of those who make a 
free use of them are suddenly stricken down while apparently in what 
should be the vigor of life. 

The action of so-called stimulants, as well as narcotics, is in reality 
a toxic effect, mistakenly supposed to be stimulation, and, like other 
poisons, the system resists them, as they are nonassimilable, and 
therefore the easiest method, by what may be called vital reaction, 
is taken to get rid of them. When from excess or weakness this 
result can not be accomplished, what may be called a benumbing 
effect is produced. The longer alcohol remains in the system the 
more will this effect be perceived, and this, being in the nature of 
paralysis, must naturally act in a progressive ratio until the impair- 
ment of the functions of the organs is succeeded by an inability to 
work at all. How would it be possible to go on, day after day, 
bathing the internal organs with dilute alcohol without its inducing 
some kind of disease? The elimination of this substance from the 
body, with its irritating compounds, necessarily falls largely upon 
the kidneys and skin, and when these are overworked, disturbance 
quickly follows. Whenever elimination is suspended, insomuch is 
one or more of the organs engorged. This is particularly disastrous 
as far as the brain is concerned, for the brain gives way most quickly 
after the reception of alcohol, and then proper coordination is 
interfered with, and we see the gradual approach toward insanity 
or idiocy, the trembling nerves, and finally utter incompetency. 

The more frequent practice is to introduce a drug into the stomach 
in hopes that its action will be such as to correct this dominating 



THE ALCOHOLIC PROBLEM. 173 

morbid condition. Necessarily this drug or potion must be absorbed, 
pass into the circulation, and then produce its effect. Were it 
possible to produce an antidote to the action of alcohol or any other 
drug, all would rejoice, but more often the result is an additional 
poison which the system is called upon to throw off through the 
excretions of the body, if possible, and while the symptoms may be 
changed, frequently the trouble is increased rather than relieved. 
The laws of life and health must be strictly obeyed, in spite of any 
so-called remedy, and we may rest assured that these laws are as 
inflexible as the law of gravitation. The time will never come when 
we may ignore any one of them without paying the full penalty. It 
will ever be found necessary to give strict attention io the laws of 
sanitation, nor can we reach the highest standard of health until 
they are fully understood and obeyed. To go on in the way of 
transgression and then expect to be bailed out by some new remedy 
is as likely to prove as futile in the future as it has in the past. 

Modern researches show most conclusively that poisons are the 
largest factors of disease, and such conditions are mostly due to toxic 
substances generated within the body, either as a result of a failure 
in the process of oxidation and elimination or the action, of microbes. 
In acute inflammatory diseases the system is struggling to expel a 
poison resulting from the growth of microbes. Typhoid fever, 
scarlet fever, diphtheria, and cancer are familiar examples. In many 
chronic conditions the body is filled with poisonous substances, the 
result of an accumulation of waste matters through defective elimina- 
tion. When a person is drowned, he dies from retained poisons. 
Experiments have shown that fatigue causes chemical changes in the 
blood, resulting in the production of a poison resembling the curare 
poison. The act of coughing is simply an effort of the nervous sys- 
tem to free the mucous membrane of the throat from obstructive 
excretion which would be poisonous were it retained. 

There is no doubt that putrefactive processes in the intestinal 
canal play an important part in many diseased conditions. The 
investigations of Selmi, Brieger, Pasteur, Frankel, and Martin con- 
firm this statement. Bouchard, in his auto-intoxication, clearly 
shows that self-poisoning is only prevented by the activity of the 
excretory organs, chiefly the kidneys, and by the watchfulness of the 
liver, which acts the part of a sentinel to the material brought to it 
by the portal vein from the alimentary canal. Lauder Brunton has 
shown that disease depends upon the products of putrefaction and 
fermentation, rather than upon the direct action of the microbes 
upon the tissues. Depression of spirits, restlessness, stupor, and 
melancholia are among the results from auto-intoxication. 

The one great fault with our people is the use of improper foods 
and drinks that satisfy not and lead to excessive alimentation. This 
is followed by a morbid craving. Ignorance supposes that stimu- 
lants are the one thing needful to satisfy this morbid craving. We 
well know that nothing will so speedily quiet the nervous storm as 
the ever-convenient and alluring alcohol, and it doe& secure, for a 
time, rest and repose, but at a fearful expense of nerve strain, after 
which comes an increased desire for further stimulation. This, oft 
repeated, is sufficient to break down the most vigorous constitution. 
Another serious effect of alcohol is its direct tendency to interfere 
with nutrition, and by promoting the growth of cellular tissue to com- 



174 THE ALCOHOLIC PKOBLEM. 

promise the integrity of the brain tissue where the poison is not 
readily thrown off, and where it soon destroys not only its coordinat- 
ing power, but degenerates the brain substance. We know that 
with the inebriate there is a lack of fine moral sense, and that this 
condition is far-reaching, even affecting the progeny. 

The following, from a report of the Belgian commission, is most 
emphatic. In brief, it says: 

First. All alcohol is injurious. It is never a tonic or stimulant and never increases 
the vital powers, but always lowers them. 

Second. No form of distilled spirits has any nutritive value. 

Third. The injuries of alcohol are always transmitted to the next generation. 

It has been" shown by the French writers, Duroy, Perrien, and 
Lailemand, that unchanged alcohol has been found in the urine- 
It has been proven by Kerr and Strumpell that the action of alco- 
hol, when brought into the system in repeated small doses, is nerve 
destruction. 

Demme, of Berne, says : 

According to the majority of investigators, absorption and assimilation are dimin- 
ished in rate by small doses of alcohol. 

Even alcohol applied to the skin is an irritant, and, if persisted 
in, will cause ulceration of the skin. 

There is one agency that accomplishes many of the results that 
different drugs are given to produce, and this without the reactive 
effect of the drug, and that is always delightful, soothing, and 
quieting to the irritated nerves. 

That agent is the hot-air bath. 

The moment the bather enters the heated chamber of this bath 
he is called upon in the gentlest manner to discharge, through the 
skin, the refuse of his system. The process of unloading goes on 
readily and constantly, and the longer he remains in the heat 
the more foul material is thrown out. The skin is made active; 
the blood is perfected in its circulation; at the same time the ele- 
ments of disease are discarded. Thus, when there is alcohol in the 
system, it can be distinctly noticed in the perspiration. It is appar- 
ent to the sense of smell, when alcohol is used in even a small degree, 
and much more so when it is freely used. As the blood is brought 
to the surface and purified it goes back to every organ to do better 
work and perfect every function, by carrying new elements of repair 
and nutrition, by which all the activities of life are renewed, so that, 
unless the work of destruction has been carried on too long, repair 
is set up and a better condition of things organized. For instance, 
if the kidneys have been inflamed, the inflammatory and obstructive 
particles are eliminated, the former irritation is quieted, there is less 
determination of blood and nervous energy to the part, through the 
general equalization, so that a normal action follows, and this vivi- 
fying process goes on, not alone with the kidneys, but with every 
organ of the body. Then, again, the manipulation which accompa- 
nies this treatment renders more perfect every process, and in a 
large measure takes the place of exercise. Nothing could be more 
simple and perfect in its action. The effect is constitutional or 
general, and thus quickly overcomes all local obstructions, and the 
process needs only to be repeated and continued long enough to 
reach the most depraved cases. 

The daily round of human life is a repetition of processes of build- 
ing up and breaking down. This change is taking piace everywnere 



THE ALCOHOLIC PROBLEM. 175 

In the human body, with the result that brain and muscle are finally 
resolved into carbonic acid, water, and ammonia. These changes 
necessarily take place much more rapidly while under the influence 
of hot air, and a person's whole system may in this way be promptly 
and completely renewed. 

By no means will this process restore a lost arm or a wasted lung, 
but by its action many an arm that by reason of inflammation was 
unfitted for service has recovered its full activity, and many a lung 
that was not doing half work has regained its normal action, and the 
brain that before was cloudy has been cleared and its pristine activity 
reinstated. 

The theory of the action of the hot-air bath is very simple. Like 
the action of the sun's rays upon Bunker Hill Monument, when shin- 
ing upon one side and causing it to lean toward the other, so does 
this agent act gently and yet powerfully. The primary action of 
heat, which is the one essential thing of the Turkish bath, is to relax 
the tissues of the body and thus invite a more perfect circulation to 
every part of the system. By this active circulation, every sense is 
quickened, the secretions are more thorough, the excretions more 
complete, the blood is better supplied with oxygen, the skin assumes 
its natural roseate complexion indicative of the improved condition, 
and each and every function, whether it be that of the lungs, liver, 
spleen, or bowels, comes in for its share of the general benefit; in a 
word, it opens every pore of the skin, and hence results the most per- 
fect sewage of the body. 

The secondary action is that resulting from the profuse sweating, 
where water from the blood and debris, or used-up tissue and poison 
held in solution are rapidly thrown out of the body. Crystallized 
salts have been noticed forming on the body of a rheumatic patient 
while in the hot room of the bath. The quantity of blood in the 
body is lessened by the free excretion which takes place through the 
skin and lungs, the body weight is reduced, and the work of the heart 
in this way lightened, at the same time that its substance is better 
nourished by the improved quality of the blood supplied to it. The 
peripheral arterioles of the body, too, become dilated and filled with 
blood, thus affecting a corresponding emptying of the blood vessels 
of the internal organs. Lastly, as a result of the alternate cold and 
warm douching the vaso-motor energy of the vessels is increased, 
thus rendering them more capable of resisting any strain that may be 
incurred. By this it will readily be seen how quickly congestion is 
broken up, wherever in the body it may be located, and the offending 
material thrown out through the pores of the skin. Under such 
conditions absorption and elimination have their most perfect oppor- 
tunity, and equalization of the circulation crowns the work. It is 
evident that alcohol is soon eradicated under such favorable condi- 
tions and that torpidity gives place to activity. Furthermore, no 
living tissue or vitality can be extracted by this process. Nothing is 
thrown off but what the system is better without. One bath has 
been known to relieve an intermittent pulse, giving a smooth, regular 
action to the heart, indicating a well-balanced circulation. What 
known drug can do this in the space of one hour? Another great 
advantage in favor of this treatment is that there is no poison left 
in the system to work its way out, as is the case when drugs are 
administered; on the contrary, the individual is left in a calm and 
quiet frame of body, which necessarily reacts upon the mind. 



176 THE ALCOHOLIC PEOBLEM. 

It must therefore be evident to every medical mind that the remedy 
which will stimulate every organ and create in it an action to throw 
off diseased conditions is a true one to meet such cases. With how 
much more reason must we expect even better results in the case of 
inebriety, where the cause of the disease is eliminated and the advan- 
tages of treatment are greater. The mucous surfaces of the inebriate, 
and in a minor degree those of the moderate drinker, are in a chronic 
state of inflammation. The effect of the hot-air treatment is to 
reduce that inflammation by purifying the blood, that is, eliminating 
the destroying elements, and thereby relieving that immoderate 
craving for stimulants, that only perpetuates and increases the dis- 
ease, instead of giving relief. A man thoroughly purified by one of 
these baths at once realizes that he is a cleaner man and on a higher 
plane; his senses are more acute; he is in his best condition; he re- 
spects himself so much the more, and is less liable to return to his 
base practices. It is stated as a fact that in no country has inebriety 
been found coexistent with the bath. Temperance and cleanliness 
are its handmaids. 

When the inebriate can be kindly taken from society, of which he 
is unable to fulfill the duties, and be cared for until he is again fitted 
for its privileges; when the younger generation are taught, as they 
should be,- the disastrous effects of stimulants and narcotics in any 
form, thanks to the noble work of the lamented Mrs. Mary H. Hunt, 
this is now being carried out in most of the public schools of our 
country, and when the Turkish bath forms a necessary adjunct to 
every habitable institution and is made generally accessible to the 
people a brighter day for mankind will dawn upon the world. 

To prevent the development of inebriety we should work for this 
enlightenment of the community and also for the establishment of 
public Turkish baths. They are democratic institutions and will 
continually tend to the social improvement of the masses by helping 
to level up its devotees to a higher grade of life. Through placing 
the body in its most vigorous and pure condition the mind at once 
receives its full share of the stimulation, and the affairs of life will be 
viewed from a broader and a cleaner standpoint. In that way it will 
help the building up of the nation. It is by the culture of the 
physical that we uplift the whole man. 

While it is remarkable how largely the Turkish bath is available in 
the relief of diseased conditions, it is capable of still more wonderful 
service in the role of preventive medicine, inasmuch as this bath 
renders its frequenters immune to disease by its purifying processes. 
Stop and think of the thousands that are lost to the community from 
easily preventable disease. It is lamentable that such a highly san- 
itary measure should not be thoroughly applied. Herein is a golden 
opportunity for wealth to magnify itself and enrich all the people. 

In fact, the eliminative power of the Turkish bath is so simple and 
yet so far reaching that its possibilities have not yet been appreciated. 
Truly we have here a field of almost unliminated range and of blessing 
to the whole community. 

As it was said in olden times, the simple things of life are contin- 
ually confounding the wise ones of the earth. 

When our people, like the Romans of old, awake to the importance 
of public Turkish baths, and model them after those of early his- 
tory, the glories of a new era, which is slowly but surely coming, will 
illumine our daily walk. 



INDEX. 



A. 

Page. 

Achard, Dr. H. J 35 

Alcohol, action on cells and tissues 16-19 

Alcohol on acute infections 46 

Alcohol as an adulterant in foods and drugs 33-34 

Alcohol in cholera and cholera infantum 99 

Alcohol in diphtheria 99 

Alcohol, effect on capacity for muscular work (Hellsten) 17 

Alcohol in erysipelas 99 

Alcohol on fatigue and endurance 17, 18, 45, 46 

Alcohol in gastro-intestinal infection 100 

Alcohol in hypostatic pulmonary congestion 98 

Alcohol, its influence on public health 42-49 

Alcohol and its influence on pulmonary tuberculosis 35-41 

Alcohol in insomnia 99 

Alcohol on life expectancy 45 

Alcohol, its place in medical practice. 144-151 

Alcohol, effect on mental work 45 

Alcohol, on mortality 44 

Alcohol in pneumonia 98, 147 

Alcohol in snake bite 100, 146 

Alcohol, Society for Study of; its objects 16 

Alcohol on temperament as it relates to race and nationality 133-136 

Alcohol on tuberculosis 47,-97, 147 

Alcohol in typhoid fever 98, 146 

Alcohol viewed from a modern standpoint 127-132 

Alcohol, water and neuropathy in man 20-22 

Alcoholic defectives ; the medico-legal care of 71-73 

Alcoholic intoxication; the responsibility of •. . 63-70 

Alcoholic poisoning; lesions of nerve cells, etc., by 9-15 

Alcoholic problem in everyday life 121-126 

Alcoholic problem, its future 140-143 

Alcoholism. (See also Inebriety.) 

Arteries, action of alcohol on 13 

Autotoxicos; auto-intoxication (Stuertz & Herter quoted) 29 

B. 

Beebe, oxidation of alcohol in liver and its effects 17 

Benton, Dr. G. H 25 

Berkley, Dr. Henry J 9 

C. 

Cholera and cholera infantum, alcohol in 99 

Collins, Dr. J., quoted on arterio-sclerosis and its effects 31, 32 

Crothers, Dr. T. D 140 

D. 

Davis, Dr. N. S., referred to ~ 155 

Diphtheria, alcohol in 99 

Dyspesia, its relations to inebriety 50-59 

S. Doc. 48, 61-1 12 177 



178 INDEX. 

E. 

Page. 

Economics of the alcoholic problem 43, 44, 45, 48, 71, 78, 127 

Effects of alcoholic beverages, social, physical, and financial 132 

Erysipelas, alcohol in 99 

Ethyl alcohol, effect of on animal organism 9-10 

F. 

Frey, Dr. H., effect of alcohol on muscular work capacity 17, 18 

Friedenwald, Dr. Julius, studies of effects of alcohol on tissue of rabbits 10, 11 

♦ G. 

Gastro-intestinal infection 100 

Gordon, Dr. Alfred 63 

H. 

Hall, Dr. W. S 16 

Hellsten, Dr. A. F., effect of alcohol on muscular work capacity 17 

Horsley, Sir Victor, on diseases due to alcohol 44, 45 

Hospital treatment of inebriety 102-108 

Hughes, Dr. Charles H 20 

Hunt, Reid, alcohol decreases defense of system against toxin 16 

I. 

Inebriate, relation to the state of pauper 74-84 

Inebriates, treatment of, in hospitals 102-108 

Inebriety and its relations to dyspepsia 50-59 

Inebriety, psychological basis of 158-169 

Inebriety, toxins as active causes of 25-32 

Inebriety, treatment of, by hydrotherapy and electricity 117-118 

Inebriety, treatment by psychic means of 109-116 

Inebriety, questions of diet in treatment of 87-101 

Inebriety, Turkish baths in 170-176 

Insomnia, alcohol in 99 

Intoxication from various causes 27 

Keister, Dr. B. C 127 

Kellogg, Dr. J. H 87 

Kelly, Dr. Howard A 121 

Kress, Dr. D. H 50 



Lawrence, Dr. G. A 71 

M. 

Marcy, Dr. Henry O 152 

Mason, Dr. Lewis D . 74 

Medical profession, temperance pioneers in 152-157 

Medico-legal care of alcoholic defectives 71-73 

Mental responsibility of chronic alcoholic cases 63-70 

Metschnikoff , reference to investigations of 20, 148 

Muscular work, effect of alcohol on capacity for 17 

N. 
Nerve elements, neuroglia action of alcohol on 14 

P. 

Parks, Dr. W. B 133 

Physicians' part in the temperance movement 137-139 

Pneumonia, alcohol in 98, 147 

Psychological basis of inebriety 158-169 



INDEX. 179 

Q. 

Fasro. 
Quackenbos, Dr. John D 109 

R. 

Rosenwasser, Dr. Charles A 102 

Rush, Dr. Benjamin, referred to 152 

S. 

Shepard, Dr. Charles H 170 

Snake bite, alcohol in 100, 146 

Stoddard, Miss Cora Frances 137 

T. 

Temperance pioneers in medical profession 152-157 

Toxins, active causes of inebriety 25-32 

Tuberculosis, alcohol in its relations to 39, 40, 47, 97, 147 

Turkish baths in inebriety 170-176 

Typhoid fever, alcohol in 98, 146 

W. 

Walton, Dr. J. C 117 

Warren, Dr. John C 153 

Waugh, Dr. W. H 144 

Webster, Dr. George W 42 

Wiley, Prof. H. W 33 

Williams, Dr. Henry Smith, articles in October and December, 1908, and Febru- 
ary 1909, McClures Magazine cited 121 

Williams, Dr. Tom A 158 

o 



LB D '03 



